Management of difficult airway in pediatric patients with right ventricular outflow tract obstruction.

We present two cases of difficult airway management for patients with Pierre Robin syndrome and right ventricular outflow tract obstruction in infants. To prevent the exacerbation of right ventricular outflow tract obstruction, adequate oxygenation and ventilation are mandatory in this population. This rule needs to be followed even while dealing with a difficult airway. Depending on the prediction of mask ventilation capability, we took two different approaches to difficult airway. In the first case, we fiberoptically intubated the patient while allowing him to breathe spontaneously with the aid of a nasopharyngeal airway under deep sedation. In the second case, we fiberoptically intubated the patient through a laryngeal mask airway while controlling ventilation. Through both cases, we highlight options of difficult airway management in the pediatric population. Although we can approach a difficult airway with or without spontaneous breathing, the important point is how we will prepare the methods to oxygenate and ventilate patients throughout the procedure. Patients with difficult airway and right ventricular outflow tract obstruction are good examples to make us realize this point.