A Comparative Study of Nasal Fiberoptic Intubation with Laryngeal Mask Airway Fiberoptic Intubation in Children with a Difficult Airway
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Abstract
Background: Considering that the gold standard for intubation in children with a difficult airway is the use of fiberoptic bronchoscopy, and few studies have evaluated its application in children, the present study aimed at comparing two bronchoscopic techniques of nasal fiberoptic tracheal intubation (FOI-Nasal) and fiberoptic intubation via laryngeal mask airway (FOI-LMA) in children with a difficult airway.
Methods: A single-blind randomized clinical trial was performed on 40 six-month-old to six-year-old children that were divided into two groups each consisting of 20 patients. The participants were all candidates for elective surgery with clinical criteria for the anticipated difficult intubation. FOI-Nasal and FOI-LMA were performed in the first and second groups, respectively. Mean arterial pressure (MAP), heart rate (HR), and blood oxygen saturation levels (SpO2) were assessed and recorded before anesthesia (T1), immediately before bronchoscopy (T2), and immediately after intubation with endotracheal tube (T3). Moreover, ETCO2, the first successful insertion attempt, and the intubation time were recorded, as well.
Results: The results of the present study revealed that parameters including MAP, HR, and SpO2 at times T1, T2, and T3 were not significantly different between the two groups after adjusting for potential confounding factors (P> 0.05). However, ETCO2 in FOI-Nasal group with a mean of 38.40 ± 3.57 was significantly higher than that of the FOI-LMA group with a mean of 34.35 ± 3.15 (P = 0.001). In addition, the intubation time in the FOI-LMA group with a mean of 32.40 ± 7.45 was significantly shorter than that of the FOI-Nasal group with a mean of 51.75 ± 9.97 (P <0.001). The success rate in the first attempt in the FOI-Nasal group with the value of 70% was lower than that of the FOI-LMA group with the value of 90%; however, this difference was not statistically significant (P> 0.05).
Conclusion: According to the results of the present study, the intubation time in the FOI-LMA group was significantly shorter than that of the FOI-Nasal group. Moreover, the success rate of the first attempt in the FOI-LMA group was higher than that of the FOI-Nasal group. Therefore, it can be stated that FOI-LMA as compared to FOI-Nasal can be regarded as an easier technique, with a shorter intubation time, a higher success rate, and a greater stability of children’s hemodynamic parameters.
[2] Desai N, Johnson M, Priddis K, Ray S, Chigaru L. Comparative evaluation of Airtraq™ and GlideScope® videolaryngoscopes for difficult pediatric intubation in a Pierre Robin manikin. Eur J Pediatr. 2019; 178(7):1105-1111.
[3] Sharma A, Dwivedi D, Sharma RM. Temporomandibular Joint Ankylosis: A Pediatric Difficult Airway Management.Anesth Essays Res. 2018; 12(1):282-284.
[4] Greenberg M, Merritt S, Brzenski A. A Novel Method of Intubation Using a Laryngeal Mask Airway and a Bronchoscope in a Premature Infant. International Journal of Innovative Medicine and Health Science, 2016; 6: 5-8.
[5] Karišik M, Janjević D, Sorbello M. Fiberoptic bronchoscopy versus video laryngoscopy in pediatric airway management. Acta Clin Croat. 2016; 55 Suppl 1:51-4.
[6] Krishna SG, Bryant JF, Tobias JD. Management of the Difficult Airway in the Pediatric Patient. J Pediatr Intensive Care. 2018; 7(3): 115-25.
[7] Reena, Vikram A. Maxillary tumor in a child: An expected case of difficult airway. Saudi J Anaesth. 2016; 10(2):233-5.
[8] Umutoglu T, Gedik AH, Bakan M, Topuz U, Daskaya H, Ozturk E, et al. The influence of airway supporting maneuvers on glottis view in pediatric fiberoptic bronchoscopy. Braz J Anesthesiol. 2015; 65(5):313-8.
[9] Bhat R, Mane RS, Patil MC, Suresh SN. Fiberoptic intubation through laryngeal mask airway for management of difficult airway in a child with Klippel-Feil syndrome. Saudi J Anaesth. 2014; 8(3):412-4.
[10] Sood S, Saxena A, Thakur A, Chahar S. Comparative study of fiber-optic guided tracheal intubation through intubating laryngeal mask airway LMA Fastrach™ and i-gel in adult paralyzed patients. Saudi J Anaesth. 2019; 13(4):290-294.
[11] Krishna SG, Syed F, Hakim M, Hakim M, Tumin D, Veneziano GC, et al. A comparison of supraglottic devices in pediatric patients. Med Devices (Auckl). 2018; 11:361-365.
[12] Hanna SF, Mikat-Stevens M, Loo J, Uppal R, Jellish WS, Adams M. Awake tracheal intubation in anticipated difficult airways: LMA Fastrach vs flexible bronchoscope: A pilot study. J Clin Anesth. 2017; 37:31-37.
[13] Lee JJ, Lim BG, Lee MK, Kong MH, Kim KJ, Lee JY. Fiberoptic intubation through a laryngeal mask airway as a management of difficult airwary due to the fusion of the entire cervical spine-A report of two cases. Korean J Anesthesiol. 2012; 62(3):272.
[14] Choi GS, Park SI, Lee EH, Yoon SH. Awake GlidescopeⓇ intubation in a patient with a huge and fixed supraglottic mass -A case report-. Korean J Anesthesiol. 2010; 59: S26-9.
[15] Kim SH, Woo SJ, Kim JH. A comparison of Bonfils intubation fiberscopy and fiberoptic bronchoscopy in difficult airways assisted with direct laryngoscopy. Korean J Anesthesiol 2010; 58: 249-55.
[16] Park SJ, Lee WK, Lee DH. Is the Airtraq optical laryngoscope effective in tracheal intubation by novice personnel? Korean J Anesthesiol. 2010; 59: 17-21.
[17] Chadd GD, Crane DL, Phillips RM, Tunell WP. Extubation and reintubation by the laryngeal mask airway in a child with the Pierre‑Robin syndrome. Anesthesiology. 1992; 76:640‑1.
[18] Beveridge ME. Laryngeal mask anesthesia for repair of cleft palate. Anaesthesia. 1989; 44:656‑7.
[19] Hasan MA, Black AE. A new technique for fibreoptic intubation in children. Anaesthesia. 1994; 49:1031‑3.
[20] Yang YS, Son CS. Laryngeal mask airway guided fiberoptic tracheal intubation in a child with a lingual thyroglossal duct cyst. Pediatr Anesth 2003; 13:829‑31.
[21[ Walker RW, Allen DL, Rothera MR. A fiberoptic intubation technique for children with mucopolysaccharidoses using the laryngeal mask airway. Pediatr Anesth. 1997; 7:421‑6.
[22] Patel A, Venn PJ, Barham CJ. Fiberoptic intubation through a laryngeal mask airway in an infant with Robin sequence. Eur J Anaesthesiol. 1998; 15:237‑9.
[23] Maekawa H, Mikawa K, Tanaka O, Goto R, Obara H. The laryngeal mask may be a useful device for fiberoptic airway endoscopy in pediatric anesthesia. Anesthesiology. 1991; 75:169‑70.
[24] Hasan MA, Black AE. A new technique for fibreoptic intubation in children. Anaesthesia. 1994; 49:1031‑3.
[25] Varghese E, Nagaraj R, Shwethapriya R. Comparison of oral fiberoptic intubation via a modified guedel airway or a laryngeal mask airway in infants and children. Journal of Anaesthesiology, Clinical Pharmacology. 2013; 29(1):52.
[26] Theiler L, Kleine‑Brueggeney M, Urwyler N, Graf T, Luyet C, Greif R. Randomized clinical trial of the i-gel™ and Magill tracheal tube or single-use ILMA™ and ILMA™ tracheal tube for blind intubation in anaesthetized patients with a predicted difficult airway. Br J Anaesth. 2011; 107:243‑50.
[27] Lee JJ, Lim BG, Lee MK, Kong MH, Kim KJ, Lee JY. Fiberoptic intubation through a laryngeal mask airway as a management of difficult airwary due to the fusion of the entire cervical spine-A report of two cases. Korean J Anesthesiol. 2012; 62(3):272.
| Files | ||
| Issue | Vol 9 No 2 (2023): Spring |
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| Section | Research Article(s) | |
| DOI | https://doi.org/10.18502/aacc.v9i2.12504 | |
| Keywords | ||
| Intubation Fiberoptic Laryngeal mask airway Nasal Children Difficult airway | ||
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