title: Retrospective audit of the air-Q intubating laryngeal airway as a conduit for tracheal intubation in pediatric patients with a difficult airway.
abstract: OBJECTIVE
  To assess the efficacy of the ILA as a conduit for tracheal intubation in pediatric patients with a difficult airway.
  
  
  OBJECTIVE
  The primary goals of this retrospective audit were to assess the clinical performance of the ILA in pediatric patients with a difficult airway, expand on our initial favorable experience with this device, and collect pilot data for future prospective and comparison studies.
  
  
  METHODS
  The charts of patients with a difficult airway in whom the ILA was used during a period of 1 year in a freestanding pediatric institution were reviewed following a practice change in the authors' institution favoring the ILA over the laryngeal mask airway as a conduit for tracheal intubation.
  
  
  RESULTS
  Thirty-four pediatric patients had an ILA placed during the course of their airway management. Eight of the 34 patients in this cohort required emergent airway management. The median age was 47.1 (0.3-202.2) months and the median weight was 16.3 (3.9-86.0) kilograms. Three of the cases were unanticipated difficult airways and the remaining were anticipated difficult airways as a result of craniofacial syndromes (n = 21), cervical spine instability or immobility (n = 7), or airway hemorrhage (n = 3). Thirty-three of the 34 patients (97%) were intubated on the first attempt through the ILA, with the aid of a fiberoptic bronchoscope (n = 25), a Shikani Optical Stylet (n = 7), or blindly (n = 2). In one patient, blind tracheal intubation required a second attempt for successful intubation, making the overall success rate 100%. Oxygen desaturation was noted in 6 of the 34 cases.
  
  
  CONCLUSIONS
  In a series of pediatric patients with difficult airways, the ILA was successfully used as a conduit for tracheal intubation in all patients. Visualization techniques may offer a greater degree of success in intubations through the ILA due to the potential for epiglottic down-folding in children.
authors.affiliation: Department of Pediatric Anesthesiology, Children's Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL 60614, USA. simjag2000@yahoo.com
authors.forename: Narasimhan
authors.initials: N
authors.lastname: Jagannathan
authors.forename: Melanie F
authors.initials: MF
authors.lastname: Kho
authors.forename: Ryan J
authors.initials: RJ
authors.lastname: Kozlowski
authors.forename: Lisa E
authors.initials: LE
authors.lastname: Sohn
authors.forename: Aisha
authors.initials: A
authors.lastname: Siddiqui
authors.forename: David T
authors.initials: DT
authors.lastname: Wong
mesh_terms: D000293:Adolescent; D058109:Airway Management / Q000295:instrumentation*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005336:Fiber Optic Technology; D005931:Glottis / Q000033:anatomy & histology; D006801:Humans; D007223:Infant; D007442:Intubation, Intratracheal / Q000295:instrumentation*; D017214:Laryngeal Masks; D007828:Laryngoscopy; D008297:Male; D010100:Oxygen / Q000097:blood; D010865:Pilot Projects; D012121:Respiration, Artificial; D012189:Retrospective Studies; D017211:Treatment Failure
chemical_list: D010100:Oxygen