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Neonatal and paediatric fibre-optic laryngoscopy and bronchoscopy using the laryngeal mask airway
A E Hinton1, J M O'Connell, J P van Besouw
1Department of Otolaryngology, St. George's Hospital, London, UK.
Insights
Fiber-optic endoscopy through a laryngeal mask airway offers a safe and effective method for examining the upper airways in infants. This technique improves visualization in challenging cases, surpassing traditional rigid scopes.
Area of Science:
- Pediatric Otolaryngology
- Neonatal Airway Management
- Flexible Endoscopy
Background:
- Traditional rigid laryngoscopy and bronchoscopy present challenges in neonates and infants due to their small airway size and potential anatomical abnormalities.
- Securing the airway for anesthesia and visualization are critical steps in pediatric upper airway examinations.
Observation:
- The laryngeal mask airway (LMA) can serve a dual purpose: airway control for anesthesia and a conduit for flexible endoscopy.
- Five cases involving neonates and infants with difficult airways underwent fiber-optic laryngoscopy and bronchoscopy using an LMA.
Findings:
- The LMA facilitated fiber-optic endoscopy, providing adequate visualization of the laryngeal inlet and beyond in cases where rigid scopes failed.
- This technique proved safe and easy to use, particularly in neonates, offering advantages over traditional ventilating bronchoscopes.
- Specific conditions managed included vascular rings, Goldenhar's syndrome, laryngomalacia, and vocal fold paresis.
Implications:
- The LMA-guided flexible endoscopy is a valuable alternative for airway assessment in challenging pediatric cases.
- This approach enhances safety and improves the diagnostic yield of upper airway endoscopy in infants.
- It offers a secure method for maintaining ventilation during endoscopy while enabling precise glottis localization.
Abstract:
Endoscopy of the upper airways in neonates and infants was traditionally been accomplished using rigid laryngoscopes and bronchoscopes. The laryngeal mask may be used both to control the airway for anaesthetic ventilation and to guide a fibre-optic endoscope to the laryngeal inlet and beyond. We report our experience with five neonatal and paediatric cases where fibre-optic laryngoscopy and bronchoscopy were performed through the laryngeal mask airway. All were cases in which standard rigid endoscopy had proved difficult with only a poor and restricted view of the laryngeal inlet being obtained due to the age of the infants, or abnormal anatomy of the upper airways. No problems have been encountered with maintenance of the airway or with endoscopic view obtained. In fact in neonatal patients, this technique has been found to be preferable with regard to safety and ease of use when compared to the ventilating bronchoscope. With the size 1 laryngeal mask airway it is not possible to simultaneously ventilate and endoscope the patient. Cases included, a vascular ring, Goldenhar's syndrome, laryngomalacia, supraglottis and vocal fold paresis. This technique provides a secure method of maintaining anaesthetic ventilation during airway endoscopy, and also a means of easily locating the glottis.