28 September 2022 – Wednesday – A Day of Challenges

I knew that our second scheduled case would be a Treacher Collins syndrome patient. The facial deformities associated with this syndrome are almost always associated with difficult intubation (that is placing a breathing tube for my non-medical readers). In fact the room next to mine started with a Treacher Collins patient too. As it turned out, the first patient decided not to have surgery so my case was moved up. 

The accompanying photo shows my patient with me and one of the surgeons in the pre-op area. She is 15 years old. Her mother abandoned her shortly after birth because of her deformity. In addition to what is visible on the photo, she has bilateral microtia(very small ears that are mostly just skin flaps without cartilage). She can hear but not well. She is otherwise mentally fully intact. She lives with her grandmother.

In anticipation of the difficult intubation, we had several possible special pieces of equipment to try to visualize her airway. Two other anesthesiologists joined me to help. It took all of us to give drugs, manage the airway and eventually get her intubated on the 4th attempt. Her oxygen saturation dropped briefly to 44 as we struggled to breathe for her using a mask but after a second small dose of succinylcholine, a very short acting paralytic, we returned her to 100% saturation and were able to intubate. 
The operation proceeded without issues. As the case ended I waited until the patient was fully awake before pulling out her tube. She appeared to be comfortable. 

Later in the recovery area she grabbed my hand and thanked me over and over. It is really a gift that goes both ways to help these unfortunate children. 

There were several cases canceled in other ORs so we decided to go out for dinner as a group to one of the nicest restaurants in town, Meson Panza Verde. The food and wine were excellent. The setting was lovely. We had reason to celebrate a successful day for all of us.