Combating Airway Issues with Elective Use of an I Gel in a Child with Goldenhar Syndrome


Vol 7 | Issue 3 | September-December 2021 | Page: 23-25 | Shilpi Sethi, Manish Sethi

DOI: 10.13107/jaccr.2021.v07i03.188

Author: Shilpi Sethi [1], Manish Sethi [2]

[1] Department of Anaesthesia, Brighton and Sussex University Hospital NHS.
[2] Department of Paediatric Opthalmology, Sitapur Eye Hospital and Regional Institute of Opthalmology, Sitapur, Uttar Pradesh, India.

Address of Correspondence
Dr. Shilpi Sethi
Clinical Fellow Anaesthetics Brighton and Sussex University Hospital NHS.

Combating Airway Issues with Elective Use of an I Gel in a Child with Goldenhar Syndrome


Introduction: Goldenhar syndrome is an oculoauriculovertebral spectrum attributed to the developmental anomalies of the first and second brachial arches. Its typical presentation in children with hemifacial microsomia poses a dual challenge for the anaesthesiologist on account of difficult airway often compounded with systemic abnormalities.
Case report: We describe a case report wherein a 5 year female presented to the oculoplastic clinic of our hospital for surgical removal of limbal dermoid under general anaesthesia. Airway examination revealed classical facial asymmetry with underdevelopment of jaw bone coupled with protruding incisors. A predicted difficult airway, more so in a child led us to choose an anaesthesia technique with preservation of spontaneous breathing and planned use of supraglottic device in the form of an I Gel for airway management.
Conclusion: The aim of this case report is to highlight the anaesthetic implications of this not so uncommon entity presenting to ophthalmology and ENT clinics. A thorough preoperative assessment, adequate preparedness and alternative plans are keys for successful airway management in such syndromic children.
Keywords: Goldenhar syndrome, hemifacial microsomia, I Gel


[1] GoldenharM. Association of the eye and forcille In particular the epidermal dermoid syndrome – appendages Auricularies – fistula auris congenital and its relations with Mandibulo – facial dysostosis J Genat Hum 1952;1:243-86.
[2] Madan R, Trikha A, Venkataraman RK, Batra R, Kalia P. Goldenhar’s syndrome: an analysis of anaesthetic management. A retrospective study of seventeen cases [published correction appears in Anaesthesia 1990 May;45(5):424]. Anaesthesia. 1990;45(1):49‐52. doi:10.1111/j.1365-2044.1990.tb14505.x
[3] Sukhupragarn W, Rosenblatt WH. Airway management in a patient with Goldenhar syndrome: a case report. J Clin Anesth. 2008;20(3):214‐217. doi:10.1016/j.jclinane.2007.09.020
[4] Altintas F, Cakmakkaya OS. General anesthesia for a child with Goldenhar syndrome. Paediatr Anaesth. 2005;15(6):529‐530. doi:10.1111/j.1460-9592.2005.01621.x
[5] Kim YL, Seo DM, Shim KS, et al. Successful tracheal intubation using fiberoptic bronchoscope via an I-gel™ supraglottic airway in a pediatric patient with Goldenhar syndrome -A case report-. Korean J Anesthesiol. 2013;65(1):61‐65. doi:10.4097/kjae.2013.65.1.61
[6] Milne AD, Dower AM, Hackmann T. Airway management using the pediatric GlideScope in a child with Goldenhar syndrome and atypical plasma cholinesterase. Paediatr Anaesth. 2007;17(5):484‐487. doi:10.1111/j.1460-9592.2006.02149.x
[7] Khalil S, Vinh B. Successful intubation of a child with Goldenhar syndrome, who previously failed intubation, using an Airtraq. Paediatr Anaesth. 2010;20(2):204‐205. doi:10.1111/j.1460-9592.2009.03223.x
[8] Jagannathan N, Sequera-Ramos L, Sohn L, Wallis B, Shertzer A, Schaldenbrand K. Elective use of supraglottic airway devices for primary airway management in children with difficult airways. Br J Anaesth. 2014;112(4):742‐748. doi:10.1093/bja/aet411
[9] Theiler LG, Kleine-Brueggeney M, Kaiser D, et al. Crossover comparison of the laryngeal mask supreme and the i-gel in simulated difficult airway scenario in anesthetized patients. Anesthesiology. 2009;111(1):55‐62. doi:10.1097/ALN.0b013e3181a4c6b9
[10] Choudhury M, Kapoor PM. Goldenhar syndrome: Cardiac anesthesiologist’s perspective. Ann Card Anaesth. 2017;20(Supplement):S61‐S66. doi:10.4103/0971-9784.197802

How to Cite this Article: Sethi S, Sethi M | Combating Airway Issues with Elective Use of an I Gel in a Child with Goldenhar Syndrome | Journal of Anaesthesia and Critical Care Case Reports | September-December 2021; 7(3): 23-25.

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