title: Using a nasopharyngeal airway during fiberoptic intubation in small children with a difficult airway.
abstract: BACKGROUND
  Induction of anesthesia and tracheal intubation in small children with a difficult airway is a challenging task. We report the experience with a procedure based on sevoflurane inhalation via a nasopharyngeal airway inserted early during induction before airway obstruction occurs. A pediatric fiberscope is used to perform a nasotracheal intubation via the opposite nostril.
  
  
  METHODS
  All small children with suspected or known difficult airway needing tracheal intubation were scheduled for a fiberoptic intubation following the described protocol.
  
  
  RESULTS
  In 3 years, we performed 27 successful fiberoptic guided tracheal intubations in 19 children, median age 8.2 months (1.0-39.1 months) and median weight 7.6 kg (3.0-15.0 kg). The optimal depth for placement of the nasopharyngeal airway was found to be 8.0 cm (7.0-8.5 cm) from the nostril in the first year of life and 8.5 cm (8.0-10 cm) in the second year. Oxygenation was sufficient during the entire procedure in all cases except one child who had short-lasting laryngeal spasm caused by instillation of lidocaine during light anesthesia. The duration of fiberoptic intubation was significantly shorter when performed by an experienced anesthesiologist (55 s vs. 120 s), but there was no significant correlation between the duration of fiberoscopy and oxygen saturation during fiberoscopy or endtidal CO(2) after intubation.
  
  
  CONCLUSIONS
  The combination of nasopharyngeal airway and fiberoptic guided tracheal intubation seems to be a reliable and safe procedure for managing the difficult airway in small children.
authors.affiliation: Department of Anaesthesia and Operating Theatre Services, Centre of Head and Orthopaedics, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej, Copenhagen, Denmark. rhk@rh.dk
authors.forename: Rolf
authors.initials: R
authors.lastname: Holm-Knudsen
authors.forename: Kirsten
authors.initials: K
authors.lastname: Eriksen
authors.forename: Lars S
authors.initials: LS
authors.lastname: Rasmussen
mesh_terms: D000402:Airway Obstruction; D018685:Anesthetics, Inhalation; D002675:Child, Preschool; D005336:Fiber Optic Technology; D006801:Humans; D007223:Infant; D007442:Intubation, Intratracheal / Q000379:methods*; D008738:Methyl Ethers; D000077149:Sevoflurane
chemical_list: D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D000077149:Sevoflurane