Anaesthetic Management of a Child Posted for Wound Closure of Upper Lip Injury - A Difficult Airway?

Dr. Harshith S, Dr. Bhagyashri, Dr. Sidramayya, Dr. Kiran Chand

Abstract: Paediatric patients with facial trauma present significant challenges for airway management due to anatomical and physiological considerations. This case report describes the anaesthetic management of a 6-year-old child with a Grade 3 dog bite avulsion injury to the upper lip and incisor, necessitating primary wound closure. Airway assessment was complicated by limited mouth opening, making both mask ventilation and intubation potentially difficult. A strategic approach including ketamine and fentanyl induction, two-hand C&E mask ventilation, and nasal intubation with a cuffed endotracheal tube ensured successful airway control. Intraoperative maintenance included sevoflurane and vecuronium, and the child was successfully reversed and monitored postoperatively without complications. This case highlights the importance of thorough preoperative evaluation, preparation for difficult airway scenarios, and adaptation of standard techniques to individual patient needs in paediatric anaesthesia.

Keywords: Paediatric airway management, difficult airway, facial trauma, nasal intubation, anaesthetic management, paediatric anaesthesia, dog bite injury