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Year : 2016  |  Volume : 3  |  Issue : 4  |  Page : 163-167

Advanced airway management of paediatric patients with anticipated difficult airway

Department of Anaesthesia and Surgical Intensive Care, Faculty of Medicine, University of Alexandria, Alexandria, Egypt

Correspondence Address:
Aliaa R. A. Abdel Fattah
Department of Anaesthesia, Alexandria University Hospital, Alexandria, 21648
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2356-9115.195875

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Background Paediatric patients have significant anatomical and physiological differences compared with adults. Furthermore, there are a number of pathological processes, which present unique anatomical or functional difficulties in airway management. Patients and methods This randomized, controlled clinical trial included 60 children (≤5 years of age with abnormal height-to-thyromental distance ratio or COPUR scale ≥12) scheduled for surgery under general anaesthesia. The patients were randomly allocated into three groups: group I underwent fibreoptic laryngoscopy (3.7 mm) through AirQ-ILA; group II underwent Miller laryngoscopy with Bonfils optical stylet; and group III underwent C-MAC videolaryngoscopy. Number of intubation attempts, total time for endotracheal tube insertion, modified Cormack and Lehane score, time for successful intubation attempt, and need for assistance were recorded. Results The modified Cormack and Lehane grade 1 was achieved in all paediatric patients included in group I compared with 65% in group II and 40% in group III. As regards the number of intubation attempts, 90% of paediatric patients included in group I had successful first intubation attempt, compared with 45 and 30% group II and group III, respectively. As regards need for assistants, group I required higher number of assistants. The total time for endotracheal tube insertion was significantly shorter in group II (62±15 s) and group III (61±12 s), demonstrating that intubation was longer in group I (207±54 s), and the time for successful attempt was significantly shorter in group II (39±3 s) and group III (33±4 s) compared with group I (199±51 s). Conclusion Flexible intubating fibrescope was superior with regard to modified Cormack and Lehane score and number of intubation attempts, whereas intubation with Bonfils optical stylet or C-MAC videolaryngoscopy was superior with regard to need for airway specialized assistants or both time for endotracheal tube insertion and time for successful intubation attempt.

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