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A generalized multistage approach to oral and nasal intubation in infants with Pierre Robin sequence: A retrospective

T Wesley Templeton1, Eduardo J Goenaga-Díaz1, Christopher M Runyan2

  • 1Section on Pediatric Anesthesia, Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina.

Paediatric Anaesthesia
|October 5, 2018
PubMed

Insights

Managing airways in infants with Pierre Robin sequence is difficult. This study successfully used a multistage approach with supraglottic airways for intubation in 13 infants, demonstrating a safe and effective technique.

Area of Science:

  • Pediatric Anesthesiology
  • Airway Management
  • Neonatal Intensive Care

Background:

  • Airway management in infants with Pierre Robin sequence presents significant challenges.
  • Specialized techniques are often necessary for successful intubation in these patients.

Purpose of the Study:

  • To review the experience with a multistage approach for oral and nasal intubation in infants with Pierre Robin sequence.
  • To evaluate the efficacy and safety of this specialized intubation technique.

Main Methods:

  • A retrospective review of 13 infants with Pierre Robin sequence undergoing intubation for procedures like mandibular distraction or gastrostomy tube placement.
  • Utilized awake placement of laryngeal mask airways (LMA-Classic™ or ProSeal™), followed by general anesthesia induction.
  • Employed a flexible fiberoptic bronchoscope for intubation through an air-Q® 1.0 device, with a modified technique for nasotracheal intubation using a nasal RAE tube.

Main Results:

  • Successful intubation was achieved in all 13 infants with Pierre Robin sequence.
  • No desaturation events occurred during LMA placement and induction, except in one critically ill infant.
  • Brief desaturation periods were noted during apneas associated with fiberoptic intubation.

Conclusions:

  • A ventilation-driven, multistaged approach utilizing various supraglottic airways facilitates oral and nasal intubation in infants with Pierre Robin sequence.
  • This method offers a viable and effective strategy for managing challenging pediatric airways.
Abstract

Keywords:
Pierre Robin syndromeairway managementgeneral anesthesiaintubationlaryngeal maskspulmonary ventilation

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