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LETTERS TO THE EDITOR

Teaching Fiberoptic Intubation in the Pediatric Patient

Christopher M. B. Heard, MD^*, Björn Gunnarsson, MD, and James E. Fletcher, MD

Departments of Department of Anesthesiology University of North Carolina Chapel Hill, NC *Anesthesiology and Division of Pediatric Critical Care and \m \^Pediatrics State University of New York at Buffalo Children’s Hospital of Buffalo Buffalo, NY

To the Editor:

Like Erb et al. (1), we are involved in teaching fiberoptic intubation skills to trainees, and we have also confronted the differences inherent in the learning situation compared with the emergent situation. Many strategies are available to facilitate management of the difficult pediatric airway in such situations (2).

We have found a simple technique that allows a trainee the opportunity to perform a fiberoptic nasal intubation in an anesthetized pediatric patient while ensuring that the patient remains well oxygenated and anesthetized during the process.

For children scheduled for elective dental procedures, anesthesia is induced in the normal manner, an IV placed and the patient paralyzed. When the patient is ready for endotracheal intubation, the inhaled anesthetic is discontinued (to control pollution) and propofol 2 mg/kg given to ensure continued anesthesia. An infant or neonatal mask is then selected, and a small oral airway is placed in the mouth. The small mask is placed over the mouth only and the patient gently ventilated with 100% oxygen. The trainee then passes the bronchoscope through the nose and attempts the intubation without being rushed. A video camera attached to the bronchoscope aids in guiding the procedure. Using this method also has the advantage that the positive pressure ventilation supports the tissues of the pharynx and minimizes the tendency for the airway to collapse when a patient is anesthetized and paralyzed. We have found that this method gives the trainee a good view of the airway anatomy, while keeping the patient anesthetized and oxygenated.

Footnotes

Dr. Erb did not wish to respond to this letter.

References

1. Erb T, Hampl KF, Schurch M, et al. Teaching the use of fiberoptic intubation in anesthetized, spontaneously breathing patients. Anesth Analg 1999; 89: 1292–5.[Abstract/Free Full Text]
2. Fletcher JE, Heard CM. Management of the pediatric airway: progress in anesthesiology. Dannemiller 1999; 13: 247–60.

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