Anesthetic management in a 2 yr old child with lymphangioma of tongue posted for wedge resection

The American Society of Anaesthesiologists (ASA) defined a difficult airway as “The clinical situation in which a conventionally trained anaesthesiologist experiences difficulty with mask ventilation, difficulty with tracheal intubation or both”. Lymphangiomas are the most common etiology of macroglossia in children. A 2 yr old female weighing 10 kg presented to paediatric surgery department with complaints of tongue protrusion since 3 months.Local examination showed non tender diffusely large tongue, protruding and keeping the mouth permanently open. Investigations revealed low Hb of 8.13 gm%, platelet count of 6.4 lac. Premedication was given in form of injglycopyrrolate 0.04mg, inj fentanyl 20 mcg, injEmset 0.2 mg. The child was first intubated orally then nasal RAE no. 4.0 uncuffed tube inserted after removal of oral endotracheal tube. The patient was successfully extubated with stable vitals. Anaesthetic management of lymapangioma of tongue is a real challenge to anaesthesiologist. The importance of a thorough preoperative evaluation, attention to difficult intubation and maintenance of airway should be emphasized.