Intubation of infants with Pierre Robin syndrome: the use of the paraglossal approach combined with a gum‐elastic bougie in six consecutive cases

Abstract

Summary Infants with Pierre Robin syndrome are known to be difficult to intubate. We evaluated the paraglossal approach combined with a gum elastic bougie for intubation of these infants. Whilst under general anaesthesia, a conventional laryngoscopy was performed; if it failed to obtain a laryngoscopic grade I or II view, intubation was attempted using a paraglossal approach and a gum elastic bougie. Six consecutive infants were studied. Conventional laryngoscopy failed in all infants whilst the paraglossal approach combined with a gum elastic bougie was successful in five of the cases. The paraglossal approach combined with a gum elastic bougie made intubation easy in most children with severe Pierre Robin syndrome and difficult laryngoscopy. Therefore we recommend this as the first line for airway management in such children. However, a fibreoptic bronchoscope and an anaesthetist trained in fibreoptic intubation must still be present when dealing with severe Pierre Robin syndrome infants.

The correct laryngoscope blade for the job

“…Similarly to Morfey [1] and Semjen's [2] experiences, we have found the straight laryngoscope blade more effective than curved blades for tracheal intubation of patients with micrognathia or short thyromental distances. In addition, we commonly use the straight blade for tracheal intubation of patients following radiotherapy for laryngeal and tongue base carcinoma where there is a low compliance of submandibular tissues.…”

“…J. Edwards K. B. Greenland P. Allen P. Cumpston Royal Brisbane and Women's Hospital Qld, Australia E-mail: mikeed01@yahoo.com Both Yates et al and Biccard discuss the indications for peri-operative statin therapy and the current lack of evidence for starting statins in patients at risk of perioperative coronary events [1,2]. Whilst there is little evidence that statin therapy reduces peri-operative risk, we feel that it would be appropriate to initiate statin therapy in patients in whom it is medically indicated.…”

The child with facial abnormalities

“…A number of intubation techniques have been described in patients with PRS. These include awake intubation [13], use of the Airtrach Disposable Optical and Stortz DCI Video laryngoscopes [14,15], blind intubation using a lightwand [16], paraglossal approach with gum elastic bougie [17] and fibre-optic intubation, which in the authors' experience, is often easier via an LMA. Fortunately, these children become easier to manage as they grow up.…”

A Novel Method of Intubation Using a Laryngeal Mask Airway and a Bronchoscope in a Premature Infant

“…In other cases it is usually desirable to remove the LMA from the mouth. Techniques to accomplish this have been described in the literature (10)(11)(12)(13)(14). Osses et al (14) reported a similar technique to what we report, using an adult intubating stylette to push the ETT off the LMA, with several important differences.…”