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Vallecular cysts frequently cause difficult intubation due to poor glottic visualization during direct laryngoscopy. The appropriate way of airway management and predictive factors of difficult intubation are unknown.We reviewed anesthetic induction and airway management in 25 cases of vallecular cysts for the past 11 years. We collected the following data of 24 cases in 20 children who were intubated under direct laryngoscopy: age (month), height (cm), weight (kg), cyst-diameter (mm), cyst-diameter to patient-height ratio, and clinical symptoms. These data were compared between difficult intubation group (group A) and easy or slightly difficult intubation group (group B).In the majority of cases, anesthesia was induced with spontaneous ventilation maintained. Group A and B consisted of 6 and 18 cases, respectively. All cases of group A required assistive devices such as stylets or tube introducers. Cyst-diameter to patient-height ratios were significantly higher in group A than in group B (0.26 vs. 0.18, P = 0.03).Because children with vallecular cysts have a risk of difficult airway, we need to prepare for difficult airway management. The cyst-diameter to patient-height ratio could be useful as a predictor of difficult intubation.

We report a case of a 3-year-old boy who had undergone total cavopulmonary connection for repair of corrected transposition of the great arteries (cTGA), and developed intractable supraventricular tachyarrhythmia. The patient was in cardiogenic shock and did not respond to antiarrhythmic drugs and cardioversion, and we used extracorporeal life support (ECLS) to maintain hemodynamics. We used dexmedetomidine to block sympathetic activity. After administration of dexmedetomidine, tachycardia was improved, and the sinus rhythm returned. No recurrence was observed. In conclusion, dexmedetomidine might be useful for intractable supraventricular tachyarrhythmia after pediatric congenital heart surgery.