Anesthetic management for dental treatment in a special needs patient with tracheal granulation tissue

We report the anesthetic management during dental treatment under general anesthesia using a flexible laryngeal mask airway (FLMA) in a patient with tracheal granulation tissue. The patient was a 7-year-old boy with cerebral palsy and tracheal granulation tissue after a tracheotomy. A physical examination revealed the patient to weight 17 kg and to have a height of 107 cm. He could not walk by himself, and he required total support because of a low level of activity. Anesthesia was induced by the inhalation of 8% sevoflurane and oxygen (6 l/min) after the start of Sp_O2 monitoring. After the loss of consciousness, the inhalation anesthetics were switched to 2%-3% sevoflurane, and BP, ECG, and BIS monitoring were initiated. A size 2.5 FLMA was easily inserted after the administration of atropine (0.1 mg). The anesthesia was maintained with sevoflurane in oxygen (Fi_O2 : 0.47) and air with acetoaminophen. In the surgical field, the rubber dam isolation technique was used to prevent contamination (saliva, hemorrhage). The pressure control ventilation setting was used throughout the procedure, and no episodes of desaturation occurred. The patient awakened fully after the anesthesia and his respiratory and hemodynamic conditions stabilized after extraction. The use of FLMA should be considered to avoid unexpected airway troubles during dental treatment in patients with tracheal granulation tissue.