Devices for difficult endotracheal intubation in children
- Brent R King, MD, MMM
Brent R King, MD, MMM
- Professor of Pediatrics and Emergency Medicine
- The Sidney Kimmel Medical College at Thomas Jefferson University
- Chief Medical Officer and Physician-in-Chief
- Nemours Alfred I DuPont Hospital for Children
- Section Editor
- Anne M Stack, MD
Anne M Stack, MD
- Section Editor — Pediatric Procedures
- Associate Professor, Department of Pediatrics
- Harvard Medical School
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
A wide range of devices have been developed to aid in the management of the difficult airway or to facilitate endotracheal intubation in adults. Many of these devices are available in sizes suitable for use in children and incorporate a variety of fiberoptic, video, optical, and mechanical technologies.
This topic will review the techniques for use of such devices for endotracheal intubation in children. The following pediatric topics on the difficult airway are presented elsewhere:
●Identification of the difficult airway (see "The difficult pediatric airway")
●Specific techniques for use of rescue devices (eg, laryngeal mask airway) when endotracheal intubation has failed (see "Emergency rescue devices for difficult pediatric airway management")
●Needle cricothyroidotomy (see "Needle cricothyroidotomy with percutaneous transtracheal ventilation")
- King, BR, Hagberg, CA. Management of the difficult airway. In: Textbook of Pediatric Emergency Medicine Procedures, 2nd edition, King, C, Henretig, FM (Eds), Lippincott, Williams & Wilkins, Philadelphia 2008. p.191.
- Semjen F, Bordes M, Cros AM. Intubation of infants with Pierre Robin syndrome: the use of the paraglossal approach combined with a gum-elastic bougie in six consecutive cases. Anaesthesia 2008; 63:147.
- Arora MK, Karamchandani K, Trikha A. Use of a gum elastic bougie to facilitate blind nasotracheal intubation in children: a series of three cases. Anaesthesia 2006; 61:291.
- Teoh CY, Lim FS. The Proseal laryngeal mask airway in children: a comparison between two insertion techniques. Paediatr Anaesth 2008; 18:119.
- Picard N, Lakhnati P, Guillerm AL, et al. [High-risk airway management in pediatric prehospital emergency medicine]. Ann Fr Anesth Reanim 2010; 29:308.
- Camkiran A, Pirat A, Akovali NV, Arslan G. Combination of laryngeal mask airway and pediatric Boussignac bougie for difficult tracheal intubation in a newborn with Goldenhar syndrome. Anesth Analg 2012; 115:737.
- Hagberg, CA. Current Concepts in the Management of the Difficult Airway. ASA Refresher Courses in Anesthesiology 2001;29:135.
- Axe R, Middleditch A, Kelly FE, et al. Macroscopic barotrauma caused by stiff and soft-tipped airway exchange catheters: an in vitro case series. Anesth Analg 2015; 120:355.
- Holzman RS, Nargozian CD, Florence FB. Lightwand intubation in children with abnormal upper airways. Anesthesiology 1988; 69:784.
- Krucylak CP, Schreiner MS. Orotracheal intubation of an infant with hemifacial microsomia using a modified lighted stylet. Anesthesiology 1992; 77:826.
- Wendling AL, Tighe PJ, Conrad BP, et al. A comparison of 4 airway devices on cervical spine alignment in cadaver models of global ligamentous instability at c1-2. Anesth Analg 2013; 117:126.
- Hung OR, Pytka S, Morris I, et al. Clinical trial of a new lightwand device (Trachlight) to intubate the trachea. Anesthesiology 1995; 83:509.
- Davis L, Cook-Sather SD, Schreiner MS. Lighted stylet tracheal intubation: a review. Anesth Analg 2000; 90:745.
- Infosino A. Pediatric upper airway and congenital anomalies. Anesthesiol Clin North America 2002; 20:747.
- Szigeti CL, Baeuerle JJ, Mongan PD. Arytenoid dislocation with lighted stylet intubation: case report and retrospective review. Anesth Analg 1994; 78:185.
- Ellis DG, Jakymec A, Kaplan RM, et al. Guided orotracheal intubation in the operating room using a lighted stylet: a comparison with direct laryngoscopic technique. Anesthesiology 1986; 64:823.
- Pfitzner L, Cooper MG, Ho D. The Shikani Seeing Stylet for difficult intubation in children: initial experience. Anaesth Intensive Care 2002; 30:462.
- Vlatten A, Aucoin S, Litz S, et al. A comparison of bonfils fiberscope-assisted laryngoscopy and standard direct laryngoscopy in simulated difficult pediatric intubation: a manikin study. Paediatr Anaesth 2010; 20:559.
- Shukry M, Hanson RD, Koveleskie JR, Ramadhyani U. Management of the difficult pediatric airway with Shikani Optical Stylet. Paediatr Anaesth 2005; 15:342.
- Audenaert SM, Montgomery CL, Stone B, et al. Retrograde-assisted fiberoptic tracheal intubation in children with difficult airways. Anesth Analg 1991; 73:660.
- Walker RW, Ellwood J. The management of difficult intubation in children. Paediatr Anaesth 2009; 19 Suppl 1:77.
- Berthelsen P, Prytz S, Jacobsen E. Two-stage fiberoptic nasotracheal intubation in infants: a new approach to difficult pediatric intubation. Anesthesiology 1985; 63:457.
- Asai T, Nagata A, Shingu K. Awake tracheal intubation through the laryngeal mask in neonates with upper airway obstruction. Paediatr Anaesth 2008; 18:77.
- Gorback MS. Management of the challenging airway with the Bullard laryngoscope. J Clin Anesth 1991; 3:473.
- Marshall KA. Complication of Bullard laryngoscope: dislodgment of blade-extender resulting in an upper airway foreign body. Anesthesiology 1998; 89:1604.
- Holm-Knudsen R. The difficult pediatric airway--a review of new devices for indirect laryngoscopy in children younger than two years of age. Paediatr Anaesth 2011; 21:98.
- Cooper RM, Pacey JA, Bishop MJ, McCluskey SA. Early clinical experience with a new videolaryngoscope (GlideScope) in 728 patients. Can J Anaesth 2005; 52:191.
- Pediatric Anesthesia 2009; 19:800.
- Vanderhal AL, Berci G, Simmons CF Jr, Hagiike M. A videolaryngoscopy technique for the intubation of the newborn: preliminary report. Pediatrics 2009; 124:e339.
- Anesth Analg 2009; 109:763.
- Pediatric Anesthesia 2010; 20:374.
- Mutlak H, Rolle U, Rosskopf W, et al. Comparison of the TruView infant EVO2 PCD™ and C-MAC video laryngoscopes with direct Macintosh laryngoscopy for routine tracheal intubation in infants with normal airways. Clinics (Sao Paulo) 2014; 69:23.
- Eisenberg MA, Green-Hopkins I, Werner H, Nagler J. Comparison Between Direct and Video-assisted Laryngoscopy for Intubations in a Pediatric Emergency Department. Acad Emerg Med 2016; 23:870.
- Sethi D. Airway management in a child with Treacher Collins syndrome using C-MAC videolaryngoscope. Anaesth Crit Care Pain Med 2016; 35:67.
- Oakes ND, Dawar A, Murphy PC. Difficulties using the C-MAC paediatric videolaryngoscope. Anaesthesia 2013; 68:653.
- Nileshwar A, Garg V. Comparison of Bullard laryngoscope and short-handled Macintosh laryngoscope for orotracheal intubation in pediatric patients with simulated restriction of cervical spine movements. Paediatr Anaesth 2010; 20:1092.
- White M, Weale N, Nolan J, et al. Comparison of the Cobalt Glidescope video laryngoscope with conventional laryngoscopy in simulated normal and difficult infant airways. Paediatr Anaesth 2009; 19:1108.
- Kalbhenn J, Boelke AK, Steinmann D. Prospective model-based comparison of different laryngoscopes for difficult intubation in infants. Paediatr Anaesth 2012; 22:776.
- Fiadjoe JE, Gurnaney H, Dalesio N, et al. A prospective randomized equivalence trial of the GlideScope Cobalt® video laryngoscope to traditional direct laryngoscopy in neonates and infants. Anesthesiology 2012; 116:622.
- Vlatten A, Aucoin S, Litz S, et al. A comparison of the STORZ video laryngoscope and standard direct laryngoscopy for intubation in the Pediatric airway--a randomized clinical trial. Paediatr Anaesth 2009; 19:1102.
- Fonte M, Oulego-Erroz I, Nadkarni L, et al. A randomized comparison of the GlideScope videolaryngoscope to the standard laryngoscopy for intubation by pediatric residents in simulated easy and difficult infant airway scenarios. Pediatr Emerg Care 2011; 27:398.
- Rodriguez-Nunez A, Oulego-Erroz I, Perez-Gay L, Cortinas-Diaz J. Comparison of the GlideScope Videolaryngoscope to the standard Macintosh for intubation by pediatric residents in simulated child airway scenarios. Pediatr Emerg Care 2010; 26:726.
- Szarpak Ł, Karczewska K, Czyżewski Ł, et al. Airtraq Laryngoscope Versus the Conventional Macintosh Laryngoscope During Pediatric Intubation Performed by Nurses: A Randomized Crossover Manikin Study With Three Airway Scenarios. Pediatr Emerg Care 2016.
- Assaad MA, Lachance C, Moussa A. Learning Neonatal Intubation Using the Videolaryngoscope: A Randomized Trial on Mannequins. Simul Healthc 2016; 11:190.
- Agrò F, Barzoi G, Montecchia F. Tracheal intubation using a Macintosh laryngoscope or a GlideScope in 15 patients with cervical spine immobilization. Br J Anaesth 2003; 90:705.
- http://www.youtube.com/watch?v=SK3tLEKQGMg&playnext=1&list=PLA09BCBD329F5B88A&index=31 (Accessed on January 10, 2011).
- CHOICE OF DEVICE
- Specialized stylets
- - Intubating introducers (gum elastic bougie)
- - Lighted stylet
- - Fiberoptic stylets
- - Flexible fiberoptic bronchoscope
- Indirect rigid laryngoscopy
- - Bullard rigid fiberoptic laryngoscope
- Video laryngoscope
- - Technique (acute angle video laryngoscope)
- SUMMARY AND RECOMMENDATIONS