title: A novel intubation technique in bilateral cleft palate pediatric patients: hard gum shield-aided intubation.
abstract: BACKGROUND
  Cleft palate anesthesia is challenging due to difficult airway. Left paraglossal intubation moves resting point of laryngoscope laterally but associated with narrower laryngoscopic view and possible trauma, and we invented the use of hard gum shield as a bridge over defective palate to facilitate intubation with possible wider window and defective tissue protection.
  
  
  METHODS
  Eighty bilateral cleft palate children, ASA physical status I-II aged 9 months to 6 years scheduled for plastic surgery had general anesthesia, were involved in prospective, controlled, randomized study, and were randomly divided by closed envelope method into two groups: group I (40 patients): intubated by hard gum shield-aided intubation and group II (40 patients): intubated by left paraglossal intubation. Both techniques compared as regards (i) intubation time; (ii) Cormack and Lehane score; (iii) need for external laryngeal manipulation; (iv) easiness of intubation: easy, modest, or difficult intubation; and (v) complications: desaturation and failed intubation.
  
  
  RESULTS
  Intubation time was shorter in group I (28.47 ± 3.78 vs. 37.63 ± 6.64 s, P = 0.001). Cormack and Lehane score was better in group I (P = 0.003). Need for external laryngeal manipulation was less in group I (P = 0.015). Easiness of intubation was better in group I (P = 0.022). No difference was found in complications between groups.
  
  
  CONCLUSIONS
  Hard gum shield-aided intubation facilitated intubation more than left paraglossal in bilateral cleft palate children with shorter intubation time, better glottic view, easier intubation, less need for laryngeal manipulation than left paraglossal intubation with no difference in complications.
authors.affiliation: Department of Anesthesiology, Beni Suef University, Beni Suef, Egypt. carnitin7@yahoo.com
authors.forename: Ahmed Abdelaal Ahmed
authors.initials: AA
authors.lastname: Mahmoud
authors.forename: Ahmed Zaghloul
authors.initials: AZ
authors.lastname: Fouad
authors.forename: Mohamed Ahmed
authors.initials: MA
authors.lastname: Mansour
authors.forename: Ahmed Mostafa
authors.initials: AM
authors.lastname: Kamal
mesh_terms: D058109:Airway Management; D019296:Capnography; D002245:Carbon Dioxide / Q000097:blood; D002648:Child; D002675:Child, Preschool; D002972:Cleft Palate / Q000601:surgery*; D005260:Female; D005881:Gingiva; D006801:Humans; D007223:Infant; D007442:Intubation, Intratracheal / Q000295:instrumentation* / Q000379:methods*; D008297:Male; D016343:Monitoring, Intraoperative; D011446:Prospective Studies; D018401:Sample Size
chemical_list: D002245:Carbon Dioxide