Bilateral Choanal Atresia

Surgeons at Dr. Mehta’s Hospitals in Chennai successfully performed critical surgery on a 10-day-old baby with blocked nasal passages. This life-threatening condition, known as bilateral choanal atresia, occurs when a membranous obstruction blocks both sides of the nasal passages, leading to extreme breathing and feeding difficulties in the infant.

The neonate’s condition was initially identified when a nasogastric (NG) tube couldn’t pass through both nasopharynx passages. Further diagnostic imaging via a CT scan confirmed the presence of membranous choanal atresia. The baby was evaluated and found to be negative for other syndromic conditions.

Due to the inherent nature of infants as obligate nasal breathers, choanal atresia symptoms manifest from day 1 of birth, including constant irritability, feeding difficulties, apneic spells, and intercostal drawing. Oxygen saturation in room air dropped to 88%, but with oxygen support, it stabilized around 98%, raising concerns about the need for immediate intervention.

The surgical procedure was performed by the skilled hands of Dr. Chandramouli and Dr. Raghavi, under general anaesthesia. Prior to the induction of anaesthesia, preoxygenation had to be done. However, due to the choanal atresia condition, it posed a real challenge, so the medical team utilized an open-mouth technique.

The anaesthesia care for the neonate was managed by the Department of Anaesthesia, headed by Dr. Dhenesh and Senior Consultant Dr. Senthil Mohan.

After administering the premedications appropriate for the baby’s weight, anaesthesia was induced using volatile agents and atracurium. Subsequently, the baby was intubated with a 3mm cuffed endotracheal tube (ETT), followed by throat packing.

The surgery involved elevating mucosal flaps from the posterior part of the septum, excising the thick membranous atretic band, and opening the nasal airways. Coblation assisted in the removal of remnant thick mucosa. A posterior septectomy was performed to connect both sides.

The procedure, conducted with the utmost precision, utilized sevoflurane in combination with a carefully balanced mixture of air and oxygen. The medical team ensured complete hemostasis to control any potential bleeding, followed by thorough suctioning and the removal of the throat pack.

The baby was successfully extubated, with a 100% success rate. To support the baby’s natural respiratory efforts post-extubation, mild positive pressure was applied through a bag and mask.

During the procedure, the medical team administered a transfusion of packed red blood cells (PRBC) of 10 ml/kg (30 ml), carefully transfused intraoperatively.

The surgery was successful as the infant’s vitals remained stable and the oxygen saturation reached 100% in room air. The baby is now doing well with normal breathing function.