Amyloidosis and Difficult Airway
Ebru Biricik, Ersel Güleç, Feride Karacaer, Dilek Özcengiz
Department of Anesthesiology and Reanimation, Çukurova University, Adana, Turkey
Amyloidosis is a disease characterized by extracellular deposition of low molecular weight protein fibrils.Amyloid deposition could seem in the heart, the liver, the kidney, skin, gut, autonomic nervous system, the tongue and carpal tunnel. Amyloidosis of tongue occurs most commonly in systemic form as rubbery macroglossia due to extra-deposition of amyloid within the suprahyoid muscle. Anesthesiologist can face to vary conditions about amyloidosis. Difficult airway due to amyloid deposition in tongue is unexpected condition. There is no report in the literature that difficult airway with amyloidosis in tongue.We aimed to report a case that had respiratory distress with extremely big tongue due to amyloidosis. We performed fiberoptic intubation for emergency tracheostomy and we didn't live any complication. Seventy-six years old male patient with respiratory distress admitted to the emergency service. He had a tongue completely filling the oral cavity and difficulty in breathing with orthopnea. He was trying to take breathe with leaning forward.His fasting period of time was enough for anesthesia. The patient was monitored using pulse oximetry, noninvasive blood pressure and electrocardiography. For nasotracheal intubation, a nasal decongestant (oximethasoline HCL) and a dose of 10 µg/kg atropine IV, as an antisialagogue agent, were administered. Then, at a dose of 0.02 mg kg-1 midazolam and 2 mg/kg ketamine IV were administered. We predicted to ventilation with face mask would not be possible and did’ nt want to lose airway control after anesthesia performed. So we aimed to maintain patients spontaneous breathing due to difficult airway. Nasal oxygen supplementation was continued from 4 L/min. While patient was on half-sitting position, endotracheal intubation was placed with fiberoptic laryngoscopy after used lubricant through left nostril.After endotracheal intubation, surgical tracheostomy was performed to the patient under general anesthesia. After then the patient was transferred to the postoperative care unit.
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