Impossible intubation in a child with severe subglottic stenosis: an alternative device to endotracheal tube (original) (raw)

Pediatric Anesthesia, 2010

Abstract

Within the last 3 years, there have been published several case reports and series regarding the successful application of new intubating devices in the pediatric setting of difficult airway management. Common for these devices are that they all give excellent views of the glottic opening. The Storz Videolaryngoscope, the Glidescope and the TruView are attractive devices in difficult airways as they occupy less space in the mouth, when compared to the Airtraq. However, despite this advantage it may still be technically difficult to direct the endotracheal tube into vision and pass it through the glottic opening. To improve the chance of successful intubation, it is necessary to use a malleable intubation stylet placed in the endotracheal tube during insertion. This technique is however not without risks in the form of iatrogenic airway injury, and accidental perforation of the palatopharyngeal arch has been reported with the use of the Glidescope (2). The Airtraq has the potential advantage, compared to the videolaryngoscopes, of having the endotracheal tube mounted in a guide channel on the side of the device thereby avoiding the potential adverse events associated with tube advancement when using other devices. The trade off however is that the Airtraq is more bulky and therefore more difficult to use it in children with limited mouth opening and narrow airway anatomy as in Pierre Robin children. Despite the good view of glottis obtained with the Airtraq, it needs to be remembered that this is no guarantee for successful intubation (as illustrated in the two cases presented here). In our practice, we have used the Airtraq successfully on several occasions in adults and older children with difficult airways as well as in infants with normal airways. However, when there is limited space in the oral cavity, the Airtraq may not be the best choice and the use of a videolaryngoscope or a fiberscope probably should be the preferred method of choice. R O L F J . H O L M-K N U D S E N* J O N A T H A N W H I T E† *Department of Anaesthesia 4231 †Department of Intensive Care 4131 Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark (email: rhk@rh.dk) References

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