Abstract

A one year old male child presented to the pediatrics emergency with difficulty in breathing for the last 10-12 days. Severe inspiratory stridor was present and the accessory muscles of respiration were active. X-ray of lateral view of the neck showed increased soft tissue shadow in front of C2 vertebra suggestive of retropharyngeal abscess. Incision and drainage of retropharyngeal abscess was planned under general anesthesia after perforsming tracheostomy, as an emergency procedure. Intravenous glycopyrrolate 50 micrograms followed by 3 mg of ketamine was given slowly till the patient became calm following which tracheotomy was carried out under local anesthesia achieved by infiltration with lignocaine by the otolaryngologist. After tracheotomy, the patient was given ketamine 5mg intravenously and oxygen: nitrous oxide (50:50) and Sevoflurane 2% through the tracheotomy tube attached to the breathing circuit with the patient breathing spontaneously. Incision and drainage of the abscess was carried out and 20ml of pus aspirated. We found ketamine to be very useful for sedation while carrying out a tracheotomy in this case.

Keywords: Retropharyngeal abscess; Ketamine; Obstructed airway

Implications General anaesthesia in pediatric patients with airway obstruction is a challenge to the anesthesiologist. We describes the anesthetic management of a child with retropharygeal abscess who was having airway obstruction. Ketamine can be life saving in these situations