Abstract: PURPOSE: To investigate anesthetic and difficult airway management in children with temporomandibular joint (TMJ) ankylosis. METHODS: Forty-three children with TMJ ankylosis and difficult airway were analyzed retrospectively . In case of spontaneous breathing, they were divided into ketamine group (K1 group) and Ketamine combined with dexmedetomidine group (K2 group). The dose of ketamine administration was 1~2 mg/kg intravenously in K1 group. In K2 group, 1 μg/kg dexmedetomidine was intravenously injected after ketamine administration.After the patients' consciousness disappearing, they were treated with intratracheal and laryngopharyngeal surface anesthesia, and intubated with fibrobronchoscopic nasal intubation. During intubation, the depth of anesthesia was maintained by adding titration of small dose of ketamine. GraphPad Prism 6.0 software was used to analyze the data. RESULTS: The children in both groups were successfully intubated through fibrobronchoscopic nasal intubation. During intubation, respiratory incidence (oxygen saturation<95%) rates in K2 group was a little lower than that in K1 group, but the difference was not significant (P>0.05). During intubation, the times of ketamine supplement in K2 group was significantly lower than that in K1 group, total ketamine dosage in K2 group was significantly lower than that in K1 group, and heart rate variation in K2 group was significantly lower than that in K1 group during intubation (P<0.05). CONCLUSIONS: Ketamine anesthesia combined with sufficient intratracheal and laryngopharyngeal surface anesthesia can accomplish the difficult airway fibrobronchoscope intubation in children with TMJ ankylosis, and ketamine combined with dexmedetomidine can make the intubation process of children's difficult airway shorter and more stable.

Key words: Children, Temporomandibular joint ankylosis, Fibrobronchoscopic nasal intubation, Ketamine, Dexmedetomidine