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Updated: Apr 4, 2026
Guidelines for Elective Pediatric Fiberoptic Intubation
Published on: January 17, 2011
The influence of airway supporting maneuvers on glottis view in pediatric fiberoptic bronchoscopy
Tarik Umutoglu1, Ahmet Hakan Gedik2, Mefkur Bakan1
1Department of Anesthesiology and Reanimation, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey.
Insights
Head tilt chin lift and triple airway maneuvers significantly improve glottic visualization during pediatric flexible fiberoptic bronchoscopy, offering better views than other tested airway maneuvers.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Medical Interventions
Background:
- Flexible fiber optic bronchoscopy is crucial for diagnosing and managing pediatric respiratory conditions.
- Optimizing visualization of the glottis is essential for successful pediatric flexible fiberoptic bronchoscopy.
Purpose of the Study:
- To evaluate the impact of various airway supporting maneuvers on glottic view during pediatric flexible fiberoptic bronchoscopy.
Main Methods:
- A randomized, controlled, crossover study included 121 pediatric patients (0-15 years) with American Society of Anesthesiologists I-II risk scores.
- Exclusion criteria included risk of difficult intubation, existing intubation or tracheostomy, and limited neck mobility.
- Patients underwent flexible fiberoptic bronchoscopy with glottic view assessed under neutral position, jaw thrust (open mouth/teeth protrusion), head tilt chin lift, and triple airway maneuvers.
Main Results:
- Jaw thrust maneuvers (open mouth and teeth protrusion) improved glottic view compared to neutral position (p<0.05).
- Head tilt chin lift and triple airway maneuvers demonstrated superior glottic visualization compared to jaw thrust maneuvers and neutral position (p<0.05).
- No significant difference was found between head tilt chin lift and triple airway maneuvers.
Conclusions:
- All tested airway maneuvers enhance glottic view during pediatric flexible fiberoptic bronchoscopy.
- Head tilt chin lift and triple airway maneuvers are the most effective techniques for improving glottic visualization in this procedure.
Introduction:
Flexible fiber optic bronchoscopy is a valuable intervention for evaluation and management of respiratory diseases in both infants, pediatric and adult patients. The aim of this study is to investigate the influence of the airway supporting maneuvers on glottis view during pediatric flexible fiberoptic bronchoscopy.
Materials And Methods:
In this randomized, controlled, crossover study; patients aged between 0 and 15 years who underwent flexible fiberoptic bronchoscopy procedure having American Society of Anesthesiologists I-II risk score were included. Patients having risk of difficult intubation, intubated or patients with tracheostomy, and patients with reduced neck mobility or having cautions for neck mobility were excluded from this study. After obtaining best glottic view at the neutral position, patients were positioned jaw trust with open mouth, jaw trust with teeth prottution, head tilt chin lift and triple airway maneuvers and best glottis scores were recorded.
Results:
Total of 121 pediatric patients, 57 girls and 64 boys, were included in this study. Both jaw trust with open mouth and jaw trust with teeth prottution maneuvers improved the glottis view compared with neutral position (p<0.05), but we did not observe any difference between jaw trust with open mouth and jaw trust with teeth prottution maneuvers (p>0.05). Head tilt chin lift and triple airway maneuvers improved glottis view when compared with both jaw trust with open mouth and jaw trust with teeth prottution maneuvers and neutral position (p<0.05); however we found no differences between head tilt chin lift and triple airway maneuvers (p>0.05).
Conclusion:
All airway supporting maneuvers improved glottic view during pediatric flexible fiberoptic bronchoscopy; however head tilt chin lift and triple airway maneuvers were found to be the most effective maneuvers.
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