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LETTERS TO THE EDITOR

Bullard Laryngoscope Proven Useful in Difficult Intubations in Children with Treacher Collins

Department of Pediatric Anesthesiology, University of Arkansas for Medical Sciences, Arkansas Children’s Hospital, Little Rock, AK

To the Editor:

We read with interest the article by Lisa Muraika et al. (1) concerning their technique of fiberoptic tracheal intubation through a laryngeal mask airway (LMA) in a child with Treacher Collins syndrome.

Prior to using an LMA to intubate the child with Treacher Collins syndrome, the authors state that they attempted direct laryngoscopy with both the MacIntosh and Miller blades, the light wand, and with fiberoptic bronchoscopy, all of which failed to reveal the vocal cords (1).

We were recently presented with a child with Treacher Collins syndrome for a laparoscopic appendectomy. Under a satisfactory level of general anesthesia, the trachea was intubated without difficulty using a Bullard laryngoscope. There were no complications, and the child tolerated the procedure well.

The Bullard laryngoscope has proven useful in difficult intubations in children with Treacher Collins syndrome (2–5).

References

1. Muraika L, Heyman JS, Shevchenko Y. Fiberoptic tracheal intubation through a laryngeal mask airway in a child with Treacher Collins syndrome. Anesth Analg 2003; 97: 1298–9.[Abstract/Free Full Text]
2. Brown RE, Vollers JM, Rader GR, Schmitz M. Nasotracheal intubation in a child with Treacher Collins syndrome using the Bullard intubating laryngoscope. J Clin Anesth 1993; 5: 492–3.[Web of Science][Medline]
3. Borland LM, Casselbrant M. The Bullard laryngoscope: a new indirect oral laryngoscope (pediatric version). Anesth Analg 1990; 70: 105–8.[Free Full Text]
4. Gorback MS. Management of the challenging airway with the Bullard laryngoscope. J Clin Anesth 1991; 3: 473–7.[Medline]
5. Shigematsu T, Miyazawa N, Yorozu T. Nasotracheal intubation using the Bullard laryngoscope [letter]. Can J Anaesth 1991; 38: 798.[Web of Science][Medline]

Response

St. Christopher’s Hospital for Children, Philadelphia, PA

In Response:

Thank you for pointing out the usefulness of intubating a difficult airway with the Bullard laryngoscope. It is especially exciting to us that the child you described also had Treacher Collins syndrome. The Bullard laryngoscope certainly should have been included in our list of alternative intubation techniques, especially with the advent of a pediatric version (1). This scope would prove most useful if it reliably succeeded in intubating patients with a difficult airway on the first attempt. This might eliminate airway trauma and swelling which often occurs after multiple laryngoscopies.

Unfortunately, we do not have a Bullard laryngoscope at our institution. It seems, however, that it would be a useful addition to our difficult airway cart.

Reference

1. Bissonnette B, Dalens B. Pediatric anesthesia: principles and practice. New York: The McGraw-Hill Companies, 2002: 483–503.

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Harea, J. Articles by Muraika, L. A. Search for Related Content PubMed PubMed Citation Articles by Harea, J. Articles by Muraika, L. A.