Fiberoptic endotracheal intubation after topicalization with in-circuit nebulized lidocaine in a child with a difficult airway.
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.


CONCLUSIONS
An in-circuit nebulization system to deliver topical lidocaine may facilitate fiberoptic-assisted intubation in anesthetized, spontaneously breathing children with compromised airways.
Tsui
Ban C H
BC
Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Alberta, Canada. btsui@ualberta.ca
Cunningham
Kirsten
K
D000287:Administration, Topical; D000769:Anesthesia, Inhalation; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use*; D001999:Bronchoscopy; D002056:Burns / Q000601:surgery; D002648:Child; D005336:Fiber Optic Technology; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D008012:Lidocaine / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D016038:Skin Transplantation
D000779:Anesthetics, Local; D008012:Lidocaine