Combination of Laryngeal Mask Airway and Pediatric Boussignac Bougie for Difficult Tracheal Intubation in a Newborn with Goldenhar Syndrome

Camkiran, Aynur; Pirat, Arash; Akovalı, Nukhet Veziroğlu; Arslan, G.

doi:10.1213/ane.0b013e31825d0a18

Cited by 3 publications

(3 citation statements)

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“…There is a paucity of literature on TTI use in infant intubations, which is limited to case reports, use for airway exchange, simulation models with anesthesiologists, and clinical descriptive use by pediatric anesthesiologist for few pediatric intubations. [17][18][19][20][21][22][23][24] In our infant simulation study, the FPS with the use of the TTI was low. Multiple airway operators commented that the device's lack of rigidity made it too difficult to direct.…”

Section: Discussionmentioning

confidence: 99%

The Pediatric Rigid Stylet Improves First-Pass Success Compared With the Standard Malleable Stylet and Tracheal Tube Introducer in a Simulated Pediatric Emergency Intubation

et al. 2022

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BackgroundPediatric emergency intubation is a high-acuity, low-occurrence procedure. Despite advances in technology, the success of this procedure remains low and adverse events are very high. Prospective observational studies in children have demonstrated improved success with the use of video laryngoscopy (VL) compared with direct laryngoscopy, although reported first-pass success (FPS) rates are lower than that reported for adults. This may in part be due to difficulty directing the tracheal tube to the laryngeal inlet considering the cephalad position of the larynx in infants. Using airway adjuncts such as the pediatric rigid stylet (PRS) or a tracheal tube introducer (TTI) may aid with intubation to the cephalad positioned airway when performing VL. The objectives of this study were to assess the FPS and time to intubation when intubating an infant manikin with a standard malleable stylet (SMS) compared with a PRS and TTI.MethodsThis was a randomized cross-over study performed at an academic institution both with emergency medicine (EM) and combined pediatric and EM (EM&PEDS) residency programs. Emergency medicine and EM&PEDS residents were recruited to participate. Each resident performed intubations on a 6-month-old infant simulator using a standard geometry C-MAC Miller 1 video laryngoscope and 3 different intubation adjuncts (SMS, PRS, TTI) in a randomized fashion. All sessions were video recorded for data analysis. The primary outcome was FPS using the 3 different intubation adjuncts. The secondary outcome was the mean time to intubation (in seconds) for each adjunct.ResultsFifty-one participants performed 227 intubations. First-pass success with the SMS was 73% (37/51), FPS was 94% (48/51) with the PRS, and 29% (15/51) with the TTI. First-pass success was lower with the SMS (−43%; 95% confidence interval [CI], −63% to −23%; P < 0.01) and significantly lower with the TTI compared with PRS (difference −65%; 95% CI, −81% to −49%; P < 0.01). First-pass success while using the PRS was higher than SMS (difference 22%, 7% to 36%; P < 0.01). The mean time to intubation using the SMS was 44 ± 13 seconds, the PRS was 38 ± 11 seconds, and TTI was 59 ± 15 seconds. The mean time to intubation was higher with SMS (difference 15 seconds; 95% CI, 10 to 20 seconds; P < 0.01) and significantly higher with the TTI compared with PRS (difference 21 seconds; 95% CI, 17 to 26 seconds; P < 0.01). Time to intubation with the PRS was lower than SMS (difference −7 seconds; 95% CI, −11 to −2 seconds; P < 0.01). The ease of use was significantly higher for the PRS compared with the TTI when operators rated them on a visual analog scale (91 vs 20 mm).ConclusionsUse of the PRS by EM and EM&PEDS residents on an infant simulator was associated with increased FPS and shorter time to intubation. Clinical studies are warranted comparing these intubation aids in children.

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Section: Discussionmentioning

confidence: 99%

The Pediatric Rigid Stylet Improves First-Pass Success Compared With the Standard Malleable Stylet and Tracheal Tube Introducer in a Simulated Pediatric Emergency Intubation

et al. 2022

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“…7 Bizim olgumuzda olduğu gibi ilk anestezi deneyiminde kateterin laringoskop eşliğinde trakeaya ilerletilememesi, ikinci uygulamada FOB ile indirekt görüntüleme altında düz bir şekilde başarısız olunması ve yine kateterin görerek ters bir şekilde yerleştirilebilmiş olması Camkıran ve ark.nın görüşünü desteklemektedir.…”

Section: Olgu Sunumuunclassified

Intubation with Fiberoptic Bronchoscope, Laryngeal Mask and Intubating Cathater in a Patient with Goldenhar Syndrome: Case Report

Pampal¹,

Demirel²,

Baltaci³

et al. 2015

Turkiye Klinikleri J Case Rep

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irinci ve ikinci brankiyal arkdan köken alan yapıların konjenital defekti sonucu ortaya çıkan Goldenhar sendromu (GS), 3000-5000 canlı doğumda bir görülür.1 Kalıtsal geçişi sporadiktir. 2 Okulo-aurikulovertebral sendrom olarak da bilinen GS fasiyal, kardiyak, renal ve vertebral anomaliler ile karakterizedir. Fasiyal asimetri, fasiyal hipoplazi ve mikrognati gibi fasiyal malformasyonlar ile oksipitalize olmuş atlas ve uzamış odontoid proses gibi vertebral anomalilere bağlı olarak gerek endotrakeal entübasyon gerekse maske ile ventilasyon mümkün olmayabilir.

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“…There are both straight and distal angled types TTIs for use down to endotracheal tube size 2.5-3.0-3.5 (30). Vygon's Bougie Boussignac has been used successfully in the intubation of infants with Pierre Robin Syndrome (31,32) and TTIs and stylets combine well with videolaryngoscopy (33). Reports of complications with the use of bougies in neonates include pneumothoraxes and bronchial trauma (34) and controversy exist about under which circumstances, if any, a neonatal bougie should be used (34).…”

Section: Tracheal Tube Introducersmentioning

confidence: 99%

Management of the Unexpected Difficult Airway in Neonatal Resuscitation

et al. 2021

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A “difficult airway situation” arises whenever face mask ventilation, laryngoscopy, endotracheal intubation, or use of supraglottic device fail to secure ventilation. As bradycardia and cardiac arrest in the neonate are usually of respiratory origin, neonatal airway management remains a critical factor. Despite this, a well-defined in-house approach to the neonatal difficult airway is often lacking. While a recent guideline from the British Pediatric Society exists, and the Scottish NHS and Advanced Resuscitation of the Newborn Infant (ARNI) airway management algorithm was recently revised, there is no Norwegian national guideline for managing the unanticipated difficult airway in the delivery room (DR) and neonatal intensive care unit (NICU). Experience from anesthesiology is that a “difficult airway algorithm,” advance planning and routine practicing, prepares the resuscitation team to respond adequately to the technical and non-technical stress of a difficult airway situation. We learned from observing current approaches to advanced airway management in DR resuscitations in a university hospital and make recommendations on how the neonatal difficult airway may be managed through technical and non-technical approaches. Our recommendations mainly pertain to DR resuscitations but may be transferred to the NICU environment.

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Combination of Laryngeal Mask Airway and Pediatric Boussignac Bougie for Difficult Tracheal Intubation in a Newborn with Goldenhar Syndrome

Cited by 3 publications

References 2 publications

The Pediatric Rigid Stylet Improves First-Pass Success Compared With the Standard Malleable Stylet and Tracheal Tube Introducer in a Simulated Pediatric Emergency Intubation

The Pediatric Rigid Stylet Improves First-Pass Success Compared With the Standard Malleable Stylet and Tracheal Tube Introducer in a Simulated Pediatric Emergency Intubation

Intubation with Fiberoptic Bronchoscope, Laryngeal Mask and Intubating Cathater in a Patient with Goldenhar Syndrome: Case Report

Management of the Unexpected Difficult Airway in Neonatal Resuscitation

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