Anesthetic Management Of Temporomandibular Joint Ankylosisand Restricted Mouth Opening In Children

Objective:To investigate the anesthetic and difficult airway management in children with temporomandibular joint(TMJ)ankylosis.Methods:The cases of children with TMJ ankylosis and limited mouth difficult airway from January 2010 to June 2018 was analyzed retrospectively.In case of spontaneous breathing,they were divided into ketamine group(K1 group)and Ketamine combined with dexmedetomidine group(K2 group).The dose of ketamine administration was 1~2mg/kg intravenously in K1 group.In K2 group,1μg/kg dexmedetomidine was intravenously injected after ketamine administration.After the patients’ consciousness disappearing,they were treated with sufficient surface anesthesia,and intubated with fibrobronchoscopic nasal intubation.During intubation,the depth of anesthesia was maintained by adding titration according to the small dose of ketamine.The safety and efficacy of the two groups in the treatment of difficult airway of temporomandibular joint(TMJ)were compared by comparing indicators such as peripheral oxygen saturation < 95% during anesthesia induction,intubation time,number of additional drugs,total dose of ketamine and rate of heart rate change.Results:The children in both groups were successfully intubated through fibrobronchoscopic nasal intubation.During intubation,respiratory incidence(oxygen saturation<95%)rates in K2 group was a little lower than that in K1 group,but the difference was not significant [8(34.78%)VS 6(30%)](P >0.05).During intubation,the times of ketamine supplement in K2 group was lower than that in K1 group,the difference was significant[3.15 ± 0.13vs4.48± 0.18](P < 0.05);total ketamine dosage in K2 group was lower than that in K1 group,the difference was significant[5.09 ± 0.11vs5.58 ± 0.14](P <0.05);heart rate variation in K2 group was lower than that in K1 group,the difference was significant[121.73±7.75vs130.7±13.8](P < 0.05);intubation time in K2 group was lower than that in K1 group,the difference was significant[13.17 ± 0.64vs16.03 ± 0.56](P < 0.05).Conclusions:Ketamine anesthesia combined with sufficient intratracheal and laryngopharyngeal surface anesthesia can accomplish the difficult airway fibrobronchoscope intubation in children with TMJ ankylosis,and ketamine combined with dexmedetomidine can make the intubation process of children’s difficult airway more stable.