Flexible Fiberoptic Bronchoscopy Through the Laryngeal Mask Airway in a Small Premature Infant

Abstract

Flexible bronchoscopy (FB) can be used safely for wider indications in children. Ultra-thin bronchoscopes are used for premature or newborn infants and are of limited diagnostic value. Bronchoscopes with a suction channel, may lead to problems when the nasal passage is narrow, particularly in patients under 2.5 kg. In addition, it may cause bronchospasm and hypoxia in small infants during the procedure because of an almost complete obstruction of the airway. A laryngeal mask airway (LMA) may prevent both bronchospasm and hypoxia because it does not need a nasal route. In addition, the LMA allows positive pressure ventilation during the procedure. We performed FB with a 3.7 mm bronchoscope through the LMA in a 75-day-old and 1910 g premature baby with atelectasis. This is the first and successful FB experience in such a small premature infant reported in the literature using a 3.7 mm bronchoscope through the LMA. INTRODUCTIONFlexible endoscopy of pediatric airways was first reported in 1978. Since then, the technique has continued to develop, and the number of flexible bronchoscopy (FB) procedures in pediatric patients has increased with the availability of smaller devices. FB in children of the age group of 0-18 years can be used safely for wider indications in children of different weights and ages. Pediatric airway bronchoscopy may involve the inspection of the nose, pharynx, larynx, trachea, and bronchi. Diagnostic indications include the evaluation of stridor, an unexplained or persistant wheeze or cough, possible malformations, recurrent atelectasis or infiltrations, hemoptysis, and collection of specimens. No certain contraindications for bronchoscopy were noted [1]. The laryngeal mask airway (LMA) has been used since 1983, and the use of bronchoscopy via the LMA of infants and children has increased with the availbility of smaller sizes of the LMA [2]. We performed FB with a 3.7 mm bronchoscope via the LMA in a 75-day-old 1910 g premature baby with atelectasis. This is the first and successful FB experience in such a small premature infant reported in the literature using a 3.7 mm bronchoscope through the LMA.