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Orotracheal fibreoptic intubation in children under general anaesthesia
P Hakala1, T Randell, O A Meretoja
1Department of Anaesthesia, University of Helsinki, Töölö Hospital, Finland.
Insights
Pediatric orotracheal fiberoptic intubation can present challenges similar to adults, including difficult tracheal tube passage and prolonged procedures. Careful manipulation is key, especially in younger children, to ensure successful intubation.
Area of Science:
- Pediatric Anesthesiology
- Airway Management
- Fiberoptic Endoscopy
Background:
- Orotracheal fiberoptic intubation is a valuable technique for managing pediatric airways.
- This study evaluates the feasibility and challenges of fiberoptic intubation in children without anticipated difficulties.
Observation:
- Eleven children aged 3 months to 8 years underwent orotracheal fiberoptic intubation.
- Three different fiberoscope diameters were utilized, selected for a snug fit within the tracheal tube.
- Mucus prolonged the procedure in one case, requiring two attempts.
Findings:
- Successful fiberoptic intubation was achieved in nine patients.
- Five patients experienced resistance during tracheal tube insertion, predominantly in those younger than two years.
- Two patients ultimately required intubation with a Macintosh laryngoscope.
Implications:
- Pediatric fiberoptic intubation shares challenges with adult procedures, such as difficulty with tracheal tube advancement after successful fiberoscopy.
- Increased resistance to tracheal tube passage is more prevalent in younger pediatric patients.
- Technique and careful manipulation are crucial for successful pediatric orotracheal fiberoptic intubation.
Abstract:
Orotracheal fibreoptic intubation under general anaesthesia in children was studied in eleven consecutive patients of three months to eight-years-of-age without anticipated intubation difficulties. One case report is also included. Three fibrescopes with a different diameter were used in the study. The fibrescope used was chosen so that it fitted snugly in the tracheal tube. The fibreoscopy was prolonged in one patient due to mucus and two tries were needed. Resistance to the tracheal tube upon intubation was encountered in five patients, only one of these patients was older than two years. Fibreoptic intubation succeeded in nine patients. Two patients were intubated with the Macintosh laryngoscope. The problems encountered in children during orotracheal fibreoptic intubation under general anaesthesia are the same as with adults: easy fibreoscopy is not always followed by easy tracheal intubation, there may be prolonged fibreoscopy and failed intubations. Manipulation of the tracheal tube can lead to successful tracheal intubation and resistance to the tube is more common in smaller children.