Fibreoptic nasal intubation in children with anticipated and unanticipated difficult intubation

Abstract

The establishment of a tracheal airway with direct laryngoscopy can be either a very difficult or an impossible task in children with congenital or acquired facial malformations. Out of 46 patients categorized as difficult tracheal intubation, fibreoptic laryngoscopy was used successfully in 44 children anaesthetized by mask with sevoflurane and oxygen or by an intravenous infusion of propofol and mask oxygenation. There were two failures (4.3%). One was due to excessive bleeding and secretions produced by the multiple attempts to intubate with direct laryngoscopy and the other failure in a patient with Pierre Robin syndrome and very small nasal passages that precluded the introduction of the endoscope. Fibreoptic laryngoscopy was successful in 37 cases (80.4%) on the first attempt to intubate and in seven (15.2%) on a second or third attempt. We conclude that fibreoptic laryngoscopy in anaesthetized children with difficult anticipated or unanticipated tracheal intubation in trained hands is a safe technique that can be lifesaving. Therefore, we urge all anaesthesia trainees to become proficient in fibreoptic tracheal intubation.

A comparative study of intubating condition and hemodynamic changes during blind nasal intubation versus fibre optic intubation in cases of temporo-mandibular joint ankylosis

“…In group A 83.3% patients were intubated in first attempt, 13.3% in second attempt and 3.3% in third attempt while only 60% patients in group B were intubated in first attempt. Hence, 40% of the patients in group B required two or more attempts as shown in Table-3. Similar to our study, Blanco et al 9 categorized 46 patients as difficult tracheal intubation, fibre optic laryngoscope was used successfully in 44 children, there were two failures. They intubated 37/40 (80.4%) of patients on I attempt and in 7 cases in II attempt.…”

A Study of Flexible Fiberoptic Bronchoscopy Aided Tracheal Intubation for Patients Undergoing Elective Surgery Under General Anesthesia

“…Mortality and morbidity have been reported in the use of FFB for intubation [10] but there were no such incidents in our study. This technique can also be used effectively even in paediatric cases [8]. We had two paediatric cases which were managed successfully.…”

“…Tracheostomy has been advocated as the method to secure the airway in deep neck space infections [7]. This failure rate of less than 4 % is less than that reported in contemporary literature which varies from 4.3 to 66 % [7,8].…”

“…Devices like various kinds of fiberoptic compatible oral airways have also been made which facilitate the process of FFB aided intubation while keeping the airway patent [13]. Out of all these methods the FFB assisted tracheal intubation is very safe and effective in the trained hands not only electively but also as back up when routine rigid laryngoscopic intubation fails [8,[14][15][16]]. An organised approach and adequate expertise in FFB are the corner stones of success [7].…”

Acute Upper-Airway Obstruction by a Lingual Thyroglossal Duct Cyst and Implications for Advanced Airway Management

“…Evidence suggests that the incidence of a difficult airway is 1-18% in adults 24-26 and may be as high as 15% in neonatal and pediatric patients. 27,28 Additionally, adult and pediatric studies have described significant morbidity and mortality associated with advanced airway management, with adverse events occurring in 14-47% of intubations. 25, 29, 30 While respiratory distress is a common presentation in neonates, 6, 31 practitioners should be vigilant in considering a broad differential diagnosis, including uncommon diagnoses such as upper airway obstruction.…”