Induction of anesthesia
Routine monitoring conducted after the patient entered the operation room showed the following vital signs: heart rate, 88 beats/min; blood pressure, 112/68 mmHg; respiration rate, 20 breaths/min; and oxygen saturation (SpO2) level, 96%. Although awake fiberoptic intubation would have been ideal, it is not preferred in a frightened child. Initially, ketamine 10 mg and dexmedetomidine 10 µg were administered. After preoxygenation for 5 min, local anesthetic topicalization of the airway was followed by administration of lignocaine 10 mg and ephedrine 5 mg. Subsequently, successful intubation was achieved by fiberoptic intubation bronchoscopy via the nasal route to find the glottis, and a lubricated tracheal tube of internal diameter 5 mm was inserted through the nostril to enter the trachea. The breathing circuit was attached through an endotracheal tube connector, and adequate spontaneous ventilation was ensured. Further anesthetics were administered routinely, and the surgery proceeded smoothly with stable intraoperative vital signs (Figure 3).
After 2 days in the intensive care unit, the extubation was performed smoothly, and the patient was discharged to the rehabilitation ward with SpO2 at 97%. The patient was discharged from the rehabilitation ward after 8 days.