Perioperative Care and Airway Management for a Patient With Sagliker Syndrome
CUREUS
Chen, Q., Lorenzo, J., Lu, A.
2020; 12 (9)
Elective Surgery and COVID-19: A Framework for the Untested Patient.
Annals of surgery
Lu, A. C., Burgart, A. M.
2020
The Tipping Point of Medical Technology: Implications for the Postpandemic Era.
Anesthesia and analgesia
Lu, A. C., Cannesson, M., Kamdar, N.
2020; 131 (2): 335–39
COVID-19 Preoperative Assessment and Testing: From Surge to Recovery.
Annals of surgery
Lu, A. C., Schmiesing, C. A., Mahoney, M., Cianfichi, L., Semple, A. K., Watt, D., Fischer, S., Wald, S. H.
2020
COVID-19: Common Critical and Practical Questions.
Anesthesia and analgesia
Lu, A. C., Sastry, S. G., Wong, B. J., Deng, A., Wald, S. H., Pearl, R. G., Tsui, B. C.
2020
N95 Respirator Alternatives And Conservation Strategies.
Anesthesia and analgesia
Wong, B. J., Lu, A. C., Tarlow, B. D., Tompkins, L. S., Chawla, A., Pearl, R. G., Wald, S. H.
2020
Determination of Length of Time for "Post-Aerosol Pause" for Patients Under Investigation or Positive for COVID-19.
Anesthesia and analgesia
Wald, S. H., Arthofer, R., Semple, A. K., Bhorik, A., Lu, A. C.
2020
Perioperative Care and Airway Management for a Patient With Sagliker Syndrome.
Cureus
Chen, Q., Lorenzo, J., Lu, A.
2020; 12 (9): e10691
Abstract
In this report, we present a case of a patient with a history of complex airway anatomy secondary to Sagliker syndrome (SS) who presented with acute exacerbation of chronic respiratory failure. The patient's difficult airway, complicated medical comorbidities, and poor psychosocial status posed a unique challenge for providing safe care during an emergency. The perioperative anesthesia service (PAS), led by critical care anesthesiologists, coordinated a multidisciplinary airway management plan. The PAS team also assisted this medically complex patient with her decision-making process. A 37-year-old female with SS, which is characterized by irreversible disfiguring of head and neck anatomy secondary to end-stage renal disease (ESRD) and poorly controlled hyperparathyroidism, presented with acute exacerbation of chronic respiratory failure due to hypervolemia. The patient's respiratory status rapidly deteriorated despite aggressive hemodialysis, requiring transfer to the ICU. Given the challenging anatomy and poor respiratory reserve in this patient, the PAS team helped coordinate a comprehensive airway plan that involved transnasal fiberoptic intubation, and in case of emergency, extracorporeal membrane oxygenation (ECMO) as a bridge to a surgical airway. During the decision-making process, the patient was found to be in psychological distress and had limited insights into her condition. The PAS team helped facilitated multidisciplinary goals-of-care discussions for the patient and her family. Fortunately, the patient's oxygenation improved with noninvasive oxygen support and aggressive hemodialysis without the need for intubation. She was discharged with outpatient follow-up appointments arranged to discuss long-term management. This is the first reported case of SS in the United States. The early involvement by the PAS team helped coordinate a multidisciplinary care plan for this patient with a difficult airway and complex comorbidities. This report highlights an innovative airway algorithm for a potentially "cannot-intubate, cannot ventilate" complex airway, and the PAS team's role in providing support for the patient's physical and psychological needs, suggesting that a comprehensive perioperative service can improve the quality and safety of care, not only for surgical patients but also for medically complex patients as well.
View details for DOI 10.7759/cureus.10691
View details for PubMedID 33133856
View details for PubMedCentralID PMC7593211
