Difficult pediatric airway management using the intubating laryngeal airway

Bennett Barch, Jeff C Rastatter*, Narasimhan Jagannathan

*Corresponding author for this work

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Objective: To evaluate the intubating laryngeal airway (ILA) in providing safe endotracheal intubation in pediatric patients with difficult airway; to describe a method for using flexible fiberoptic bronchoscopy with the ILA for evaluating the pediatric airway. Methods: Case series with chart review of the medical records of patients who had the ILA and fiberoptic intubation used to secure the airway at a tertiary pediatric hospital from January 2009 to January 2011. We documented the circumstances necessitating airway management, ILA success, airway evaluation findings, and medical conditions contributing to difficult airway. Results: Fifty patients met criteria for review. The median age was 59.8 months (0.3-244.1), and the median weight was 19.0. kg (2.6-86). Four cases (8%) were unanticipated difficult airways and 46 (92%) were anticipated difficult airways. Nine (18%) of the 50 procedures were performed emergently. Comorbid conditions included craniofacial syndromes (n=36), cervical spine instability/immobility (n=9), and airway hemorrhage (n=3). 48 (96%) patients were fiberoptically intubated on first attempt through the ILA. In 2 patients, fiberoptic intubation required a second attempt. The overall success rate using the ILA and fiberoptic intubation to secure the airway was 100%. Conclusion: ILA and fiberoptic-guided tracheal intubation is a safe and effective method for securing the airway in pediatric patients with difficult airway and can be a useful alternative to direct laryngoscopy when laryngeal exposure is suboptimal.

Original languageEnglish (US)
Pages (from-to)1579-1582
Number of pages4
JournalInternational Journal of Pediatric Otorhinolaryngology
Volume76
Issue number11
DOIs
StatePublished - Nov 1 2012

Fingerprint

Airway Management
Pediatrics
Intubation
Laryngoscopy
Pediatric Hospitals
Intratracheal Intubation
Bronchoscopy
Tertiary Care Centers
Medical Records
Spine
Hemorrhage
Weights and Measures

Keywords

  • Air-Q
  • Bronchoscopy
  • Difficult airway
  • Fiberoptic intubation
  • Intubating laryngeal airway
  • Micrognathia
  • Pediatric airway evaluation

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Otorhinolaryngology

Cite this

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title = "Difficult pediatric airway management using the intubating laryngeal airway",
abstract = "Objective: To evaluate the intubating laryngeal airway (ILA) in providing safe endotracheal intubation in pediatric patients with difficult airway; to describe a method for using flexible fiberoptic bronchoscopy with the ILA for evaluating the pediatric airway. Methods: Case series with chart review of the medical records of patients who had the ILA and fiberoptic intubation used to secure the airway at a tertiary pediatric hospital from January 2009 to January 2011. We documented the circumstances necessitating airway management, ILA success, airway evaluation findings, and medical conditions contributing to difficult airway. Results: Fifty patients met criteria for review. The median age was 59.8 months (0.3-244.1), and the median weight was 19.0. kg (2.6-86). Four cases (8{\%}) were unanticipated difficult airways and 46 (92{\%}) were anticipated difficult airways. Nine (18{\%}) of the 50 procedures were performed emergently. Comorbid conditions included craniofacial syndromes (n=36), cervical spine instability/immobility (n=9), and airway hemorrhage (n=3). 48 (96{\%}) patients were fiberoptically intubated on first attempt through the ILA. In 2 patients, fiberoptic intubation required a second attempt. The overall success rate using the ILA and fiberoptic intubation to secure the airway was 100{\%}. Conclusion: ILA and fiberoptic-guided tracheal intubation is a safe and effective method for securing the airway in pediatric patients with difficult airway and can be a useful alternative to direct laryngoscopy when laryngeal exposure is suboptimal.",
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author = "Bennett Barch and Rastatter, {Jeff C} and Narasimhan Jagannathan",
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Difficult pediatric airway management using the intubating laryngeal airway. / Barch, Bennett; Rastatter, Jeff C; Jagannathan, Narasimhan.

In: International Journal of Pediatric Otorhinolaryngology, Vol. 76, No. 11, 01.11.2012, p. 1579-1582.

Research output: Contribution to journalArticle

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AU - Jagannathan, Narasimhan

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N2 - Objective: To evaluate the intubating laryngeal airway (ILA) in providing safe endotracheal intubation in pediatric patients with difficult airway; to describe a method for using flexible fiberoptic bronchoscopy with the ILA for evaluating the pediatric airway. Methods: Case series with chart review of the medical records of patients who had the ILA and fiberoptic intubation used to secure the airway at a tertiary pediatric hospital from January 2009 to January 2011. We documented the circumstances necessitating airway management, ILA success, airway evaluation findings, and medical conditions contributing to difficult airway. Results: Fifty patients met criteria for review. The median age was 59.8 months (0.3-244.1), and the median weight was 19.0. kg (2.6-86). Four cases (8%) were unanticipated difficult airways and 46 (92%) were anticipated difficult airways. Nine (18%) of the 50 procedures were performed emergently. Comorbid conditions included craniofacial syndromes (n=36), cervical spine instability/immobility (n=9), and airway hemorrhage (n=3). 48 (96%) patients were fiberoptically intubated on first attempt through the ILA. In 2 patients, fiberoptic intubation required a second attempt. The overall success rate using the ILA and fiberoptic intubation to secure the airway was 100%. Conclusion: ILA and fiberoptic-guided tracheal intubation is a safe and effective method for securing the airway in pediatric patients with difficult airway and can be a useful alternative to direct laryngoscopy when laryngeal exposure is suboptimal.

AB - Objective: To evaluate the intubating laryngeal airway (ILA) in providing safe endotracheal intubation in pediatric patients with difficult airway; to describe a method for using flexible fiberoptic bronchoscopy with the ILA for evaluating the pediatric airway. Methods: Case series with chart review of the medical records of patients who had the ILA and fiberoptic intubation used to secure the airway at a tertiary pediatric hospital from January 2009 to January 2011. We documented the circumstances necessitating airway management, ILA success, airway evaluation findings, and medical conditions contributing to difficult airway. Results: Fifty patients met criteria for review. The median age was 59.8 months (0.3-244.1), and the median weight was 19.0. kg (2.6-86). Four cases (8%) were unanticipated difficult airways and 46 (92%) were anticipated difficult airways. Nine (18%) of the 50 procedures were performed emergently. Comorbid conditions included craniofacial syndromes (n=36), cervical spine instability/immobility (n=9), and airway hemorrhage (n=3). 48 (96%) patients were fiberoptically intubated on first attempt through the ILA. In 2 patients, fiberoptic intubation required a second attempt. The overall success rate using the ILA and fiberoptic intubation to secure the airway was 100%. Conclusion: ILA and fiberoptic-guided tracheal intubation is a safe and effective method for securing the airway in pediatric patients with difficult airway and can be a useful alternative to direct laryngoscopy when laryngeal exposure is suboptimal.

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