title: Successful tracheal intubation through an intubating laryngeal airway in pediatric patients with airway hemorrhage.
abstract: BACKGROUND
  This case report describes the use of the air-Q intubating laryngeal airway (air-Q ILA; Cookgas LLC, St. Louis, MO) for airway rescue and a conduit for blind tracheal intubation in two pediatric patients with failed rapid sequence intubation and difficult airways secondary to airway bleeding in the emergency department (ED).
  
  
  OBJECTIVE
  To describe the use of a new supraglottic rescue device in the management of the pediatric patient's difficult airway in the emergency setting.
  
  
  METHODS
  Case 1 was a 5-year-old boy who presented to the ED for bleeding one day after his tonsillectomy. After a rapid sequence intubation, direct laryngoscopy was difficult, with copious bleeding in the oropharynx and inability to visualize the glottis. After two failed direct laryngoscopic attempts to intubate, a size-2 air-Q ILA was inserted. A cuffed 5.0-mm inner diameter (ID) endotracheal tube (ETT) was blindly inserted through the lumen of the air-Q ILA into the trachea successfully. Case 2 was a 13-year-old boy who presented to the ED with a large nasopharyngeal laceration from a motor vehicle accident. After a rapid sequence intubation, direct laryngoscopy showed copious blood with no glottic visualization. A size 3 Laryngeal Mask Airway Classic™ (cLMA; LMA North America Inc., San Diego, CA) was inserted with a large airway leak, and blind ETT insertion via the cLMA was unsuccessful. Subsequently, a size-2.5 air-Q ILA was inserted and adequate ventilation was restored. A cuffed 6.0-mm ID ETT was blindly inserted through the air-Q ILA into the trachea successfully.
  
  
  CONCLUSIONS
  Two cases of failed laryngoscopy in pediatric patients with blood in the airway are described. In each case, insertion of an air-Q ILA was followed by successful blind tracheal intubation via the lumen of the air-Q ILA.
authors.affiliation: Department of Pediatric Anesthesiology, Children's Memorial Hospital, Northwestern University's Feinberg School of Medicine, Chicago, Illinois 60614, USA.
authors.forename: Narasimhan
authors.initials: N
authors.lastname: Jagannathan
authors.forename: David T
authors.initials: DT
authors.lastname: Wong
mesh_terms: D000063:Accidents, Traffic; D000293:Adolescent; D000402:Airway Obstruction / Q000628:therapy*; D002675:Child, Preschool; D004635:Emergency Medicine / Q000379:methods; D006470:Hemorrhage / Q000150:complications*; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D008297:Male; D009305:Nasopharynx / Q000293:injuries; D019106:Postoperative Hemorrhage / Q000150:complications; D016896:Treatment Outcome