A case report: Anaesthetic management in a child with Rosai-Dorfman disease undergoing cervical lymph node excisional biopsy

Rosai-Dorfman disease (RDD) is a benign, self-resolving disorder often characterized by cervical lymphadenopathy. This raises complications for anaesthesiologists given the multiorgan involvement, particularly with the airway, which complicates mask breathing and intubation. A 14-year-old girl diagnosed with Rosai-Dorfman disease received an excisional biopsy for bilateral cervical oedema that had persisted for one year. She had received treatment with dexamethasone and sirolimus and had a recent history of mumps infection. The PET-CT revealed significant lymphadenopathy and hypermetabolic lesions. A complicated airway cart was constructed in the operation room. Standard monitors were used, and the patient underwent preoxygenation. Mask ventilation was difficult owing to oedema; nevertheless, sufficient breathing was accomplished using a size 1 oropharyngeal airway. Anaesthesia was initiated with ketamine after the achievement of sufficient anaesthetic depth. Succinylcholine was administered as a muscle relaxant, and intubation was successfully performed with a 5.5 mm uncuffed tube via video laryngoscopy. Anaesthesia was sustained using oxygen, nitrous oxide, isoflurane, and muscle relaxants. The procedure carried out without any further challenges. and the patient was extubated after complete recovery from anaesthesia. RDD may complicate airway care due to lymphadenopathy and soft tissue tumours. In this instance, achieving an adequate mask fit proved difficult; yet, intubation was executed successfully without difficulties, underscoring the need of readiness for tough airway situations. This case highlights the importance of thorough pre-anaesthetic assessment and careful intraoperative management in patients with RDD undergoing surgical procedures.4