Anaesthetic concerns of difficult airway in case of large oral hemangioma posted for robotic cystectomy

Khevna Kapadia, Sheetal Shah, Hemant Mehta, Misha Mehta


A difficult airway poses a challenge to attending anaesthesiologist. Fibreoptic intubation (FOI) to secure airway can be a valuable option in such a scenario. Steep Trendelenberg’s position with pneumoperitoneum in robotic surgery causes respiratory changes with airway oedema and congestion. We are describing here a case report of 56-year male patient with a large congenital oral cavity hemangioma with primary urothelial neoplasm of bladder posted for robotic radical cystectomy with ileal conduit with urethrectomy. We emphasize the importance of difficult airway management by using fibre optic technique in such cases complicated by steep Trendelenburg’s position required during robotic surgeries.


Difficult extubation, Fibreoptic intubation, Oral cavity hemangioma, Robotic surgery

Full Text:



Joshi C, Ambi U, Prakashappa DS, Mirji P. Anaesthetic considerations in macroglossia due to hemangioma of tongue a case report. J Clin Diagnostic Res. 2011;5:840-42.

Puppala N, Deshmukh SN. Cavernous hemangioma of tongue: management of two cases. J Clin Diagn Res. 2014;8:ZD15-17.

Bajwa SS, Panda A, Bajwa SK, Singh A. Anesthetic and airway management of a child with a large upper-lip hemangioma. Saudi J Anaesth. 2011;5:82-4.

Dilsiz A, Aydin T, Gursan N. Capillary hemangioma as a rare benign tumor of the oral cavity: a case report. Case J. 2009;2:8622.

Kutluhan A, Bozdemir K, Ugras S. The treatment of a tongue haemangioma by using a plasma knife surgery. Singapore Med J. 2008;49:312.

Robotic Lee JR. Anesthetic considerations for robotic surgery. Korean J Anesthesiol. 2014;66:3-11.

Hsu RL, Kaye AD, Urman RD. Anesthetic Challenges in Robotic-assisted. Urol Surg Rev Urol. 2013;15:178-84.

Maerz DA, Beck LN, Sim AJ, Gainsburg DM. Complications of robotic-assisted laparoscopic surgery distant from the surgical site. British J Anaesthesia. 2017;118 (4):492–503.

Baltayian S. A brief review: anaesthesia for robotic prostatectomy. J Robotic Surg. 2008;2:59-66.