Successful tracheal intubation through an intubating laryngeal airway in pediatric patients with airway hemorrhage

Narasimhan Jagannathan*, David T. Wong

*Corresponding author for this work

Research output: Contribution to journalArticle

17 Scopus citations

Abstract

Background: This case report describes the use of the air-Q intubating laryngeal airway (air-Q ILA; Cookgas LLC, St. Louis, MO) for airway rescue and a conduit for blind tracheal intubation in two pediatric patients with failed rapid sequence intubation and difficult airways secondary to airway bleeding in the emergency department (ED). Objectives: To describe the use of a new supraglottic rescue device in the management of the pediatric patient's difficult airway in the emergency setting. Case Report: Case 1 was a 5-year-old boy who presented to the ED for bleeding one day after his tonsillectomy. After a rapid sequence intubation, direct laryngoscopy was difficult, with copious bleeding in the oropharynx and inability to visualize the glottis. After two failed direct laryngoscopic attempts to intubate, a size-2 air-Q ILA was inserted. A cuffed 5.0-mm inner diameter (ID) endotracheal tube (ETT) was blindly inserted through the lumen of the air-Q ILA into the trachea successfully. Case 2 was a 13-year-old boy who presented to the ED with a large nasopharyngeal laceration from a motor vehicle accident. After a rapid sequence intubation, direct laryngoscopy showed copious blood with no glottic visualization. A size 3 Laryngeal Mask Airway Classic™ (cLMA; LMA North America Inc., San Diego, CA) was inserted with a large airway leak, and blind ETT insertion via the cLMA was unsuccessful. Subsequently, a size-2.5 air-Q ILA was inserted and adequate ventilation was restored. A cuffed 6.0-mm ID ETT was blindly inserted through the air-Q ILA into the trachea successfully. Conclusion: Two cases of failed laryngoscopy in pediatric patients with blood in the airway are described. In each case, insertion of an air-Q ILA was followed by successful blind tracheal intubation via the lumen of the air-Q ILA.

Original languageEnglish (US)
Pages (from-to)369-373
Number of pages5
JournalJournal of Emergency Medicine
Volume41
Issue number4
DOIs
StatePublished - Oct 1 2011

Keywords

  • air-Q ILA
  • difficult airway in pediatrics
  • emergency airway in pediatrics
  • laryngeal mask airway (LMA)
  • proseal LMA
  • rapid sequence intubation

ASJC Scopus subject areas

  • Emergency Medicine

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