Laryngeal mask airway guided tracheal intubation in a neonate with the Pierre Robin syndrome

Abstract

Endotracheal intubation in infants with the Pierre Robin syndrome may sometimes be impossible to accomplish by conventional means. To aid difficult tracheal intubation many different techniques have been described. We present a case, in which we successfully intubated a small-for-date newborn boy with the Pierre Robin syndrome by using a modified laryngeal mask airway (no. 1) as a guide for the endotracheal tube. The technique is easy to perform, less traumatic and less time-consuming than multiple attempts at laryngoscopy or blind tracheal intubation.

Alternative Ventilation Strategies: Laryngeal Masks

“…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]. The ETT either was advanced blindly into the larynx through the mask or was advanced over a fiberoptic bronchoscope that had been placed through the mask.…”

“…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]…”

“…The included studies were classified into eight levels of evidence by study design and methodology following a modification of the system described by the American Heart Association and International Liaison Committee on Resusci- Abouleish [42], Auden [43], Carenzi [44], Cortez [45], Ellis [46], Hansen [47], Hinton [48], Johr [49], Lesmes [50], Lonnqvist [51], Lopez-Gil [11], Markakis [52], Mecklem [53], Oliva [54], Park [55], Puebla [56], Shank [57], Theroux [58], Trevisanuto [59],…”

The ‘dedicated airway’: a review of the concept and an update of current practice

“…Individual case reports have also described a variety of techniques [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]. Catheter exchange techniques are usually only feasible if adequate ventilation is achieved when the LMA is in position.…”

The Laryngeal Mask Airway (LMA)

“…While no technique or device is guaranteed to be effective, the LMA has been used to manage the airways of children with many different types of congenital anomalies. These include the following: Freeman-Sheldon syndrome, 71 Pierre-Robin syndrome, 72,73 Schwartz-Jampel syndrome, 74 Beckwith-Wiedemann syndrome, 75 and laryngotracheo-esophageal clefts. 76 Many more congenital anomalies affecting airway anatomy are referenced in the bibliography at www.LMANA.com.…”