Difficult intubation in a small for gestational age newborn by bonfils fiberscope

Caruselli, Marco; Zannini, Rita; Giretti, Roberto; Rocchi, G; Camilletti, Gianfranco; Bechi, Patrizia; Ventrella, Francesco; Pallotto, Roberta; Pagni, Raffaella

doi:10.1111/j.1460-9592.2008.02595.x

Cited by 17 publications

(15 citation statements)

References 6 publications

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“…There have been isolated reports of the use of the Bonfils as a rescue device in difficult intubation of small babies. This includes a case of a neonate with mandibular hypoplasia and large tongue , and an 18‐month‐old boy with partial trisomy 1 mosaic . The authors of these reports highlighted the ease of use of this instrument in small babies, and the atraumatic nature of the device.…”

Section: Discussionmentioning

confidence: 99%

Use of the Bonfils intubating fibrescope in a baby with a severely compromised airway

Krishnan

Thiessen

2013

Pediatric Anesthesia

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We report the successful use of a 2-mm rigid Bonfils intubation endoscope as a rescue device in a 5-week-old baby presenting with an unstable airway due to massive macroglossia and multiple hemorrhagic lymphangiomata compressing the airway and resulting in a Cormack and Lehane grade 4 view. The limited intraoral space rendered it impossible to visualize the laryngeal inlet or insert a laryngeal mask, Glidescope or Airtraq blade into the patient's mouth. A 2-mm Bonfils fibrescope passed easily into the patient's mouth and facilitated a grade 1 view of the laryngeal inlet with subsequent successful intubation at first attempt with a 3.5-mm uncuffed endotracheal tube. There are very few alternatives to rescue such an airway in this age group with this type of pathology and surgical intervention would have been difficult due to the vascular nature of the lesion. Bonfils intubation endoscopes (Karl Storz Endoscopy, Tuttlingen, Germany) are a series of reusable devices consisting of a rigid metal tube with a fixed 40° anterior tip curvature containing a fibreoptic bundle. They are available in three sizes with outside diameters of 2, 3.5, or 5 mm. The advantage of the pediatric 2-mm Bonfils fibrescope is that it allows intubation with a 2.5-mm endotracheal tube. There is a paucity of the literature pertaining to the use of the Bonfils endoscope as a rescue device for intubation of small infants and neonates. In our case, the infant's airway was compromised as a result of a receding mandible, large protruding tongue, glottic distortion, and limited intraoral space. This prevented the use of bulkier rescue airway devices with the potential for traumatic manipulation, which could have lead to rapid deterioration of an already unstable airway. We feel that many clinicians are unaware of the benefits of the Bonfils fibrescope and suggest further studies to increase its use in elective and emergency situations.

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Section: Discussionmentioning

confidence: 99%

Use of the Bonfils intubating fibrescope in a baby with a severely compromised airway

Krishnan

Thiessen

2013

Pediatric Anesthesia

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“…It is available in 2, 3.5 , and 5 mm external diameters, sizes with the 2 mm being appropriate for most neonatal intubations. Caruselli et al describe the successful intubation of a small for gestational age full-term neonate with failed direct laryngoscopy using the Bonfi ls fi berscope using a 2.5 mm endotracheal tube [ 40 ]. Bein et al described their experience with the Bonfi ls fi berscope Anesthesia Challenges for the Diffi cult and Critical Neonatal Airway in 55 children (mean age 6 years); they reported an increased failure rate, and increased time to successful intubation in children with normal airways [ 41 ].…”

Section: Optical Stylletesmentioning

confidence: 97%

Anesthesia Challenges for the Difficult and Critical Neonatal Airway

Fiadjoe

Isserman

McCloskey

2014

Disorders of the Neonatal Airway

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The larynx descends as children grow and is most cranially positioned in the neonate [ 1 ]. The high cervical position of the larynx is often described as being "anterior" because of the view obtained with direct laryngoscopy. Because of the high location of the glottis, straight blades are thought to offer better exposure of the larynx because of the ability to elevate the base of the tongue. Despite this, some clinicians prefer curved blades and use them successfully. Other consequences of the high location of the neonate's glottis include the tendency for laryngeal masks to become dislodged and inadvertent compression of the airway in the neck during bag-mask ventilation.The tongue in the neonate is relatively large and may obstruct the airway by adhering to the palate; relief can be obtained by opening the mouth or by applying continuous positive airway pressure (CPAP), to the airway via a bagmask device. An oral airway is rarely needed to open the airway of a neonate. The neonatal epiglottis is relatively short. This allows one to elevate the tip by simply placing the straight laryngoscope blade in the vallecula much like how a curved blade is used. The glossoepiglottic ligament located in the vallecula should be engaged with the tip of the straight blade in order to gain adequate glottic exposure. The vocal cords in the neonate are slanted rostrally as compared to the vocal cords in the adult. This can cause diffi culties in passing an endotracheal tube because the tip is already directed in an upward fashion to the anteriorly located larynx causing it to have a greater chance of being hung up at the anterior commissure or anterior tracheal wall. Classically, it has been taught the neonatal airway is funnel shaped, but a recent study suggests it may be tubular much like the adult airway [ 2 ]. Traditionally teaching is that the narrowest part of the neonatal/pediatric airway is at the cricoid ring and not at the vocal cords like the adult airway.Normal cardiopulmonary physiology can also make the management of the neonatal airway diffi cult.In the operating room (OR), the initial approach to a patient with a diffi cult airway is to perform an inhalational induction with a volatile anesthetic agent to allow for spontaneous ventilation. This can be done successfully in a neonate; however, the response is different due to differences in physiology. Theoretically, uptake of the volatile anesthetic can be delayed due to the relatively higher cardiac output; however, the higher minute ventilation and increased proportion of cardiac output to the brain in the neonate can actually increase the rate of induction. The faster rate of induction and effects on the neonatal brain subsequently leads to a faster decrease in respiratory function as compared to older children and adults (Fig. 1a ).Neonates are also more prone to develop hypoxia during the process of securing the airway due to differences in lung volumes and metabolic rate as compared to children and adults. In neonates, the functional residual capacity is ap...

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“…[3][4] The instrument is available in various sizes and its design makes intubation easy under direct visualization. [3][4] The instrument is available in various sizes and its design makes intubation easy under direct visualization.…”

Section: Intubation Using a "Bonfils Fiberscope" In A Patient With Pfmentioning

confidence: 99%

“…3 Although there are data relating to airway management in the preburn center setting, 4 and also data regarding the long-term sequela of airway burns, 5 there are no strict guidelines for the FIGURE 1. 1,2 Airway obstruction can result from deposition of the products of incomplete combustion and the sloughing of cellular debris.…”

Section: Extensive Mucosal Sloughing and Tracheobronchial Cast After mentioning

confidence: 99%

Intubation Using a “Bonfils Fiberscope” in a Patient With Pfeiffer Syndrome

Caruselli

Giretti²,

Pallotto³

et al. 2011

Journal of Bronchology &Amp; Interventional Pulmonology

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Difficult intubation in a small for gestational age newborn by bonfils fiberscope

Cited by 17 publications

References 6 publications

Use of the Bonfils intubating fibrescope in a baby with a severely compromised airway

Use of the Bonfils intubating fibrescope in a baby with a severely compromised airway

Anesthesia Challenges for the Difficult and Critical Neonatal Airway

Intubation Using a “Bonfils Fiberscope” in a Patient With Pfeiffer Syndrome

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