ABSTRACT : Pierre Robin Syndrome is a rare condition with micrognathia causing air¬way obstruction in the neonates and often associated with failure to thrive. When cleft palate is present in a Pierre Robin child, then the airway management becomes a dreaded night¬mare to the anaesthesiologist

METHODS : We had a 1 yr old male child , known case of Pierre Robin Syndrome with severe upper airway obstruction since birth , for which tracheostomy was done at 15 days of life , subsequently closed at 5 months of age , coming for surgical closure of palate. Child had severe micrognathia and was an anticipated difficult airway.

The child was induced with sevoflurane and oxygen . Initially anesthesia was maintained with sevoflurane administered through a nasopharyngeal airway connected to Jackson Rees circuit. Simultaneously a 3.8 mm OD paediatric FOB was introduced through the other nostril and the vocal cords were visualized on a monitor connected to the FOB and Intubation was done using a 3.5 mm ETT through Indirect visualisation. Post procedure anticipating upper airway obstruction , child was extubated over a pediatric exchange catheter.

RESULTS : In our case scenario, intubation and extubation was challenging and use of FOB and AEC enabled us to manage the case with ease

CONCLUSIONS : In an anticipated difficult airway, both FOB and AEC can prove vital for securing the airway