title: Comparison of oral fiberoptic intubation via a modified guedel airway or a laryngeal mask airway in infants and children.
abstract: BACKGROUND
  Though fiberoptic intubation (FOI) is considered the gold standard for securing a difficult airway in a child, it may be technically difficult in an anesthetized child. The hypothesis for this study was that it would be easier to perform FOI via a laryngeal mask airway (LMA) than a modified oropharyngeal airway with the advantage of maintaining anesthesia and oxygenation during the process.
  
  
  METHODS
  30 children aged 6 months to 5 years undergoing elective surgery under general anesthesia were randomized to two groups to have fiberoptic bronchoscope (FOB) guided intubation either via a modified Guedel airway (FOB-ORAL) or a classic LMA (FOB-LMA). In the FOB-LMA group, the LMA was removed when a second smaller endotracheal tube was anchored to the proximal end of the tracheal tube in place.
  
  
  RESULTS
  Oral fiberoptic intubation was successful in all children. The first attempt success rate was 11/15 (73.33%) in the FOB-LMA group and 3/15 (20%) in the FOB-ORAL group (P = 0.012). Subsequent attempts at intubation were successful after 90° anticlockwise rotation of the endotracheal tube over the FOB. The time taken for fiberoptic bronchoscopy was significantly less in FOB-LMA group (59.20 ± 42.85 sec vs 108.66 ± 52.43 sec). The incidence of desaturation was higher in the FOB-ORAL group (6/15 vs 0/15).
  
  
  CONCLUSIONS
  In children, fiberoptic bronchoscopy and intubation via an LMA has the advantage of being easier, with shorter intubation time and continuous oxygenation and ventilation throughout the procedure. Removal of the LMA following intubation requires particular care.
authors.affiliation: Department of Anaesthesiology, Kasturba Medical College, Manipal, Manipal University, Karnataka, India.
authors.forename: Elsa
authors.initials: E
authors.lastname: Varghese
authors.forename: R
authors.initials: R
authors.lastname: Nagaraj
authors.forename: R
authors.initials: R
authors.lastname: Shwethapriya
keywords: Difficult; equipment; fiberoptic bronchoscope; intubation; laryngeal mask airway; modified oropharyngeal Guedel airway; tracheal