The ultra-thin bronchoscope in management of the difficult paediatric airway

Abstract

The ultra-thin bronchoscope in management of the difficult paediatric airway The use of an ultra-thin flexible fiberoptic bronchoscope with a single lumen diameter of 2.7 ram at the distal tip to assist intubation of paediatric patients with o difficult airway is reported. Two patients (ages 30 months and 18 months) with mandibular hypoplasia and one patient (three months) with the Pierre-Robin syndrome are reported. In each case two fiberoptic bronchoseopes were used. The first allowed introduction of topical local atmesthetic while the second and smaller one was used for tube placement. The use of the fiberoptic bronchoscope is widely accepted in the management of a "difficult airway" in adults.t However, application of this technique to infants and children has been limited by the size of available instruments. Until recently, the smallest bronchofiberscope allowed minimum tube sizes of 4.5 mm ID. Consequently, alternative techniques such as blind nasal intubation, or the "retrograde approach" are still advocated in the literature. ',3 Another problem with the "difficult paediatric airway" is the choice of anaesthetic. Adequate immobilisation must be assured to allow atraumatte introduction of the instrument while allowing sufficient spontaneous respiration to avoid hypoxia. In 1979, Alfery et al. 4 reported a successful "'contralateral fiberoptic nasal intuhation" ~3f a newborn with congenital ankylosis of the jaws under ketamine anaesthesia.

Dificuldade de intubação traqueal em paciente com craniossinostose: relato de caso

“…When facing a difficult TI in children, it is accepted that tracheal intubation should be performed under general anesthesia with drugs which allow spontaneous ventilation 2,7,8 . Bronchofibroscopy, introduced in the last decade, has proven to be an efficient method and the most indicated one for extremely difficult intubations [9][10][11][12][13][14] . The development of ultra-fine flexible bronchoscopes (2.2 mm diameter) allows TI with tubes starting at 2.5 mm of internal diameter, with low incidence of complications.…”

“…Diante de um caso de IOT difícil em crianças, admite-se que na fase de intubação traqueal deve-se empregar anestesia geral com utilização de drogas que permitam ventilação espontânea 2,7,8 . O advento da broncofibroscopia desde a década passada tem-se mostrado um método eficiente e o mais indicado para IOT extremamente difícil [9][10][11][12][13][14] . O desenvolvimento do broncoscópio flexível ultra-fino, 2,2 mm de diâmetro, permite realização da IOT com tubos a partir de 2,5 mm de diâmetro interno, com pequena incidência de complicações.…”

Paediatric Bronchoscopy

“…Endotracheal intubation by passage of the tube over a flexible bronchoscope is useful when the larynx is impossible to visualise by conventional means. 21 Bronchoscopy through an endotracheal tube will confirm tube position and is a useful adjunct to selective endobronchial intubation. Bronchoscopy is particularly valuable in the critically ill child with pneumonia or recalcitrant atelectasis because it involves minimal disturbance to the ventilated patient.…”

Sedation and fiberoptic intubation of a neonate with a cystic hygroma

“… The flexible bronchoscope (FB) has been used to secure the difficult airway in pediatric patients (1). Difficult intubations in patients with cystic hygromas have been performed in awake patients or after the induction of general anesthesia (2).…”