Retrograde fibreoptic intubation in a child with Nager's syndrome

H. J. Przybylo*, G. W. Stevenson, Frank A. Vicari, Babette Horn, Steven C. Hall

*Corresponding author for this work

Research output: Contribution to journalArticle

13 Scopus citations

Abstract

Purpose: The authors describe a retrograde fibreoptic technique for tracheal intubation in a micrognathic child with a tracheocutaneous fistula. Clinical features: A four-year-old child with Nager's syndrome presented for surgical closure of a tracheocutaneous fistula. A tracheostomy tube had been placed in the neonatal period for management of upper airway obstruction due to severe micrognathia. At 21/2 yr of age, after a successful mandibular advancement procedure, the tracheostomy was removed and the child allowed to breathe through the natural airway. Preoperative physical examination revealed an uncooperative child, unable to open her mouth due to limited temporo-mandibular motion. The child was first anaesthetized with ketamine, 70 mg im, then halothane by mask. The authors were unable to open the child's mouth sufficiently to allow rigid laryngoscopy. Attempts at oral and nasal fibreoptic intubation were unsuccessful. Ultimately, the authors were able to intubate nasally by passing an ultrathin Olympus LF-P laryngoscope under direct vision through the tracheocutaneous fistula in a cephalad direction, through the larynx and nasopharynx, then out the nares. An endotracheal tube was then advanced over the fibreoptic scope and positioned distal to the tracheocutaneous fistula. The surgical procedure was successfully accomplished and the trachea was extubated postoperatively without difficulty. Conclusion: Retrograde fibreoptic intubation may be an option for airway management of a select group of children who cannot be intubated by traditional techniques.

Original languageEnglish (US)
Pages (from-to)697-699
Number of pages3
JournalCanadian Journal of Anaesthesia
Volume43
Issue number7
StatePublished - Jul 1 1996

Keywords

  • ANAESTHESIA
  • INTUBATION: fibreoptic
  • SYNDROMES: Nager's
  • paediatric: Nager's syndrome
  • retrograde

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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