Awake Fibreoptic Intubation via a Laryngeal Mask in an Infant with Goldenhar's Syndrome

Difficult intubation in paediatrics

“…Fibreoptic intubation has also been described through a laryngeal mask airway (50)(51)(52)(53)(54). A problem common to this technique is the lack of sufficient length of exposed tracheal tube to allow subsequent removal of the laryngeal mask airway (55).…”

Successful tracheal intubation using fiberoptic bronchoscope via an I-gel™ supraglottic airway in a pediatric patient with Goldenhar syndrome -A case report-

“…There is also a case of successful fiberoptic bronchoscopic intubation in a 6-year-old patient with right facial deformity and occipitocervical fusion [5]. In addition, one case reported a successful pediatric fiberoptic bronchoscopic intubation through an LMA during a planned trancheostomy for respiratory failure in a 19-day-old infant (3.6 kg) while the infant was awake [6]. It was also reported, in a case in which airway obstruction occurred after extubation in a 4-month-old baby, that an open airway was maintained using an LMA [7].…”

“…An LMA is considered a very useful device for airway management [4,6,7]. Also, an LMA can be used as a passage for intubation, as evidenced by Johnson's use of an LMA as an method of airway management to administer anesthesia to an infant in tracheostomy.…”

Alternative Ventilation Strategies: Laryngeal Masks

“…Observational studies describing laryngeal masks used with neonates to administer anesthesia, to facilitate endotracheal intubation, or to facilitate diagnostic bronchoscopy were assigned to level of evidence 7 (extrapolation) regardless of methodology. In total, our search identified 48 relevant studies, including one Cochrane systematic review [15], one small randomized controlled trial [16], two nonrandomized cohort studies [2,17], three large uncontrolled case series [18][19][20], three mechanical or animal models [21][22][23], and multiple smaller case series or individual case reports for neonatal resuscitation [24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] and other nonresuscitation purposes [11,[42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57]…”

“…Most of these publications are single case reports or retrospectively collected case series and typically have involved subjects with craniofacial anomalies requiring perioperative airway management. Sixteen case reports describe a total of 18 neonatal patients in whom a laryngeal mask was used as a lifesaving rescue airway during resuscitation when facemask ventilation and endotracheal intubation had been unsuccessful [24][25][26][27][28][29][30][31][32]34,[36][37][38][39][40][41]. Several additional reports describe the laryngeal mask used to guide intubation when direct laryngoscopy was unsuccessful [30,36,43,46,47,58,[61][62][63].…”