Rigid nasendoscope with video camera system for intubation in infants with Pierre-Robin sequence

Abstract

We describe an alternative intubation technique using a rigid nasendoscope and a video camera monitor system in two infants with Pierre-Robin sequence presenting for palatoplasty. After induction with an inhalational anaesthetic technique, the tracheas of the infants could not be intubated with direct laryngoscopy using a Wisconsin blade. In the absence of a flexible paediatric fibrescope, a rigid endoscope (2.7 mm, 70 degrees lateral illumination) was passed orally to provide a view of the glottis on the monitor screen. A tracheal tube, bent into a J-shape using a stylet, was inserted orally and manipulated into the trachea, under video guidance. This technique proved to be simple, permitting a favourable view of the glottis. It should be considered for passing a tracheal tube through the vocal cords in infants who present with a difficult airway.

Nasal fiberoptic–guided oral tracheal intubation in neonates and infants with Pierre Robin sequence

“…There are several methods of securing the difficult airway in neonates and infants. Some of these include using neonatal fiberoptic bronchoscopes, rigid endoscopic guidance (2) or using a fiberoptic bronchoscope with a guide wire inserted through the suction channel and using the guide wire to pass the tracheal tube (3). As our pediatric fiberoptic bronchoscope does not have a suction channel, it was not possible to use the guide wire method.…”

Improvement in Cormack and Lehane grading with laparoscopic assistance during tracheal intubation

“…used a rigid nasendoscope connected to a video camera to intubate a child with Pierre Robin syndrome. [12] They hypothesized that if the tongue is lifted away from the posterior pharyngeal wall, glottic view from the pharynx is suitable with 70 D lateral illumination but we achieved the same with 30 D lateral illumination. The longer length of the scope offered the additional advantage of allowing the assistant and the anaesthesiologist to share the airway and at the same time allowing introduction of the TT from the lateral corner of the mouth.…”

Video assisted fiberoptic intubation for temporomandibular ankylosis

“…The bronchoscope is the most difficult scope to use and requires a very experienced bronchoscopist to ensure successful intubation. At our institution we have used a rigid nasendoscope to secure airway in infants with suspected difficult airway (2). This technique might not be feasible in TMJ ankylosis.…”