An elective Front-of-neck-access as an escape room in a case of tumour obstructing the airway in a child: a case report.

backgroundLittle agreement exists on how to perform emergency front of the neck access (eFONA) in children less than 8 years old in cannot intubate-cannot oxygenate (CICO) situations. This uncertainty arises due to the scarcity of evidence and the predominant emphasis on CICO prevention in most paediatric difficult airway management guidelines and algorithms. An elective FONA can be implemented as a bridging technique for an anticipated CICO scenario.We present here a case of performing an elective FONA as a bridging technique in a paediatric patient with the airway obstruction caused by a gigantic tonsillar mass. CASE REPRESENTATION: An 8-year-old previously healthy child presented with a throat mass, associated with choking during sleep and drooling of saliva. The mass appears in the throat and covers the uvula when the child opens his mouth. A Computer tomography of the neck with contrast demonstrated a large oropharyngeal mass lesion measuring 37 × 33 × 54 mm, significantly compromising the airway. He was admitted for an elective oropharyngeal mass excision. The landmarks for cricothyroidotomy and tracheostomy were marked on the child's skin before administering anaesthesia. After adequate pre-oxygenation, the intravenous and inhalational anaesthetics were administered judiciously to keep the ventilation spontaneous. A High Flow Nasal Oxygenation was provided throughout the airway management. An attempt at oral endotracheal intubation using video-laryngoscopy failed, after which an immediate needle cricothyroidotomy was performed by surgeons to avoid impending airway loss. A flow controlled manual ventilation was performed via a 16-G cannula to oxygenate patient. The second trial of intubation was not successful. It was decided to perform a tracheostomy for the completion of the surgery. Subsequently, the patient was intubated orally after an oropharyngeal mass excision and right tonsillectomy. The tracheal stoma was closed considering a high risk of tracheal stenosis. The patient was transferred to the paediatric intensive care, where he was extubated after 24 h.

conclusionEn elective FONA should be considered as a bridging technique in the management of an anticipated upper airway obstruction caused by tumours in children. Early recognition and appropriate management of an airway obstruction are crucial for preventing potential complications associated with airway loss.