Introduction: Choanal atresia is a well-recognized condition characterized by an anatomical closure of the posterior choanae in the nasal cavity.
Case presentation: We report the case of a term female infant from first normal pregnancy. During routine delivery room aspiration an obstruction of the upper airways was suspected due to failure of passing a suction catheter through the nasal passages. The infant was transferred to neonatal intensive care unit where after initial sedation with phenobarbital and midazolam was intubated and assisted ventilation was initiated. A nasogastric tube was inserted for feeding. The diagnosis of bilateral bony choanal atresia was confirmed by a CT scan. On the 7th day of life, the infant was transported from the NICU of ACC University Hospital Tokuda to the Department of ENT Surgery in University Hospital “Queen Giovanna” – ISUL for surgical treatment. Under general anesthesia a transnasal endoscopic choanoplasty was performed and bilateral stents were inserted. After the surgery the patient was transported back to the NICU of ACC University Hospital Tokuda in a stable condition for additional intensive care and treatment.
Discussion: Complex pathologies must be managed in a coordinated way by the ‘multidisciplinary team’ approach. Bilateral choanal atresia in the infant may present as a life-threatening respiratory distress immediately after birth or later at the first feeding. When diagnosed the main priority is to ensure free airway. This can be achieved by the use of different oropharyngeal devices or by endotracheal intubation. The perioperative anesthetic management of neonates is challenging even for the experienced anesthesiologist. Neonatal anesthesia demands profound understanding of the rapidly changing physiology of the neonate and both the pharmacokinetics and pharmacodynamics of the medications used to provide anesthesia.
Conclusion: Successful management of complicated medical cases with complex pathologies require modern approach and close coordination between different specialties. Our therapeutic success is a result of the close collaboration between the anesthesia, surgery and neonatology teams.
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