Lighted stylet-guided intubation via the intubating laryngeal airway in a patient with Hallermann-Streiff syndrome

Abstract

Purpose Hallermann-Streiff syndrome is a congenital syndrome associated with oculomandibulofacial abnormalities and potentially difficult airways. This case report describes the novel use of a lighted stylet-guided tracheal tube insertion through a new supraglottic airway, the intubating laryngeal airway (ILATM), in a patient with Hallermann-Streiff syndrome who had anticipated difficult airway. Clinical features A 26-year-old male with Hallermann- Streiff syndrome was scheduled for a vitrectomy. The patient had mandibulofacial dystocia with a bird-like appearance, a mouth opening of 4 cm, a receding chin, and a Mallampati class 3 examination. The surgeon requested muscle paralysis and no movement during surgery. After receiving midazolam, fentanyl and propofol, a size 3.5 ILATM was inserted and lung ventilation was easy to perform. A 7.5-mm internal diameter tracheal tube was mounted on a lighted stylet with its inner rigid stylet removed. After succinylcholine administration, the lighted stylet-tracheal tube assembly was inserted via the ILATM until the transillumination just vanished below the sternal notch. The lighted stylet was removed, the circuit was connected, and capnography confirmed tracheal placement of tube. The ILATM was deflated and left in situ. Upon emergence from anesthesia, the tracheal tube, and subsequently the ILATM, were removed without complications. Conclusions This case presents a novel use of a lighted stylet-guided tracheal tube insertion through the ILATM in a patient with Hallermann-Streiff syndrome. This intubation technique can be considered in patients with difficult airways as a primary route of intubation, or as a secondary rescue strategy. © Canadian Anesthesiologists' Society 2008.