Rigid Video Laryngoscopy for Intubation in Severe Pierre Robin Sequence: A Retrospective Review

Area of Science:

• Pediatric Anesthesiology
• Airway Management
• Craniofacial Anomalies

Background:

• Children with severe Pierre Robin sequence present unique airway challenges for intubation.
• Advanced techniques like flexible fiberoptic laryngoscopy require specialized skills and equipment.
• Rigid video laryngoscopy's utility in this specific pediatric population has not been previously documented.

Purpose of the Study:

• To evaluate the effectiveness of rigid video laryngoscopy for endotracheal intubation in children with Pierre Robin sequence.
• To compare the first-attempt success rates of direct laryngoscopy, rigid video laryngoscopy, and flexible fiberoptic laryngoscopy in this cohort.

Main Methods:

• Retrospective cohort study of children with Pierre Robin sequence undergoing mandibular distraction osteogenesis (January 2016 - March 2020).
• Analysis of intubation events, comparing success rates across different laryngoscopy techniques.
• Univariate logistic regression used to compare intubation success rates.

Main Results:

• Rigid video laryngoscopy achieved an 80.5% first-attempt success rate, significantly higher than direct laryngoscopy (47.3%).
• Flexible fiberoptic laryngoscopy showed a high first-attempt success rate (88.9%).
• Direct laryngoscopy was four times more likely to fail the first intubation attempt compared to rigid video laryngoscopy (P < .05).

Conclusions:

• Rigid video laryngoscopy is a more accessible and effective first-line intubation device for children with Pierre Robin sequence.
• This technique should be considered in both operating room and emergent settings for this patient group.
• No significant difference in success was found between rigid video laryngoscopy and flexible fiberoptic laryngoscopy.