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PEDIATRIC ANESTHESIA

Fiberoptic Endotracheal Intubation After Topicalization with In-Circuit Nebulized Lidocaine in a Child with a Difficult Airway

*Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Alberta, Canada

Address correspondence and reprint requests to Ban C. H. Tsui, MD, MSc, FRCP(C), Department of Anesthesiology and Pain Medicine, University of Alberta Hospitals, 3B2.32 Walter Mackenzie Health Science Centre, 8440-112 St., Edmonton, Alberta, Canada T6G 2B7. Address e-mail to btsui{at}ualberta.ca

This case report describes the successful fiberoptic intubation of an uncooperative child with a difficult airway due to gross burn scarring in the facial and neck region by administering 4% end-tidal sevoflurane and simultaneously delivering 4% nebulized lidocaine via a small-volume nebulizer that was connected to the inspiratory limb of the circle system via a T-piece adapter. This case suggests that simultaneously administering a volatile anesthetic with nebulized lidocaine might be an alternative way to deliver lidocaine and might provide better topical anesthesia for uncooperative patients.

IMPLICATIONS: An in-circuit nebulization system to deliver topical lidocaine may facilitate fiberoptic-assisted intubation in anesthetized, spontaneously breathing children with compromised airways.

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				F. S. Xue, C. W. Li, K. P. Liu, H. T. Sun, G. H. Zhang, Y. C. Xu, and Y. Liu Circulatory Responses to Fiberoptic Intubation in Anesthetized Children: A Comparison of Oral and Nasal Routes Anesth. Analg., February 1, 2007; 104(2): 283 - 288. [Abstract] [Full Text] [PDF]