Fibreoptic nasal intubation in children with anticipated and unanticipated difficult intubation

Authors

  • Gerardo Blanco,

    1. Departments of Thoracic Surgery and Endoscopy, Anesthesia and Respiratory Therapy, Oral and Maxillofacial Surgery and Plastic Surgery, Hospital Infantil de México ‘Dr Federico Gómez’ and Hospital Angeles del Pedregal, Mexico City, Mexico
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  • Estela Melman,

    1. Departments of Thoracic Surgery and Endoscopy, Anesthesia and Respiratory Therapy, Oral and Maxillofacial Surgery and Plastic Surgery, Hospital Infantil de México ‘Dr Federico Gómez’ and Hospital Angeles del Pedregal, Mexico City, Mexico
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  • Vicente Cuairan,

    1. Departments of Thoracic Surgery and Endoscopy, Anesthesia and Respiratory Therapy, Oral and Maxillofacial Surgery and Plastic Surgery, Hospital Infantil de México ‘Dr Federico Gómez’ and Hospital Angeles del Pedregal, Mexico City, Mexico
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  • Diana Moyao,

    1. Departments of Thoracic Surgery and Endoscopy, Anesthesia and Respiratory Therapy, Oral and Maxillofacial Surgery and Plastic Surgery, Hospital Infantil de México ‘Dr Federico Gómez’ and Hospital Angeles del Pedregal, Mexico City, Mexico
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  • Fernando Ortiz-Monasterio

    1. Departments of Thoracic Surgery and Endoscopy, Anesthesia and Respiratory Therapy, Oral and Maxillofacial Surgery and Plastic Surgery, Hospital Infantil de México ‘Dr Federico Gómez’ and Hospital Angeles del Pedregal, Mexico City, Mexico
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E.MelmanDr Bosque de Alerces #125, Bosques de las, Lomas, 11700 México, D.F., México.

Abstract

The establishment of a tracheal airway with direct laryngoscopy can be either a very difficult or an impossible task in children with congenital or acquired facial malformations. Out of 46 patients categorized as difficult tracheal intubation, fibreoptic laryngoscopy was used successfully in 44 children anaesthetized by mask with sevoflurane and oxygen or by an intravenous infusion of propofol and mask oxygenation. There were two failures (4.3%). One was due to excessive bleeding and secretions produced by the multiple attempts to intubate with direct laryngoscopy and the other failure in a patient with Pierre Robin syndrome and very small nasal passages that precluded the introduction of the endoscope. Fibreoptic laryngoscopy was successful in 37 cases (80.4%) on the first attempt to intubate and in seven (15.2%) on a second or third attempt. We conclude that fibreoptic laryngoscopy in anaesthetized children with difficult anticipated or unanticipated tracheal intubation in trained hands is a safe technique that can be lifesaving. Therefore, we urge all anaesthesia trainees to become proficient in fibreoptic tracheal intubation.

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