[The use of dexmedetomidine and Airwayscope in airway management of a child with Cornelia de Lange syndrome].

We report anesthetic management of a 22-month-old child with Cornelia de Lange syndrome scheduled for palatoplasty because of cleft palate. Micrognathia and short neck of the patient suggested difficult airway management. For anesthetic induction, 1 microg x kg(-1) dexmedetomidine was loaded intravenously, followed by infusion at a rate of 0.7 microg x kg(-1) x hr(-1) with incremental inhalation of sevoflurane. During the induction, spontaneous breathing was maintained. By laryngoscopy with Machintosh blade after intravenous propofol for the purpose of laryngeal reflex inhibition, only the tip of epiglottis was seen. Then, after another intravenous propofol, laryngoscopy was performed with Airwayscope, which enabled operators to see the glottis. Then, a RAE endotracheal tube (ID 4.5 mm) was inserted. During the Airwayscope operation, pharyngeal reflex, laryngeal reflex and saliva increase were inhibited resulting in good view of the larynx and the lowest Spo2 was 94% temporarily. After intubation, anesthesia was maintained with sevoflurane, remifentanil and fentanyl. Dexmedetomidine infusion was also useful to maintain adequate spontaneous breathing and to achieve awaking before extubation.