Nasal fiberoptic intubation: A savior during handling a pediatric difficult airway

Intubating a pediatric patient with temporomandibular joint ankylosis is a daunting task, and it becomes more challenging with limited mouth opening. Fiberoptic nasotracheal intubation technique is considered a gold standard. We describe an improvised technique of securing airway in the absence of appropriate-sized fiberoptic scope. The endotracheal tube inserted in the left nostril for maintaining depth of anesthesia was advanced under vision by the fiberoptic scope inserted into the right nostril, and with external laryngeal manipulation, the airway was secured with no complications.

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“…[ 6 ] However, the fiberoptic nasal intubation is a gold standard technique, but this is also fraught with challenges. [ 7 ]…”

Section: Discussionmentioning

confidence: 99%

Temporomandibular joint ankylosis: “A pediatric difficult airway management”

Sharma¹,

Dwivedi²,

Sharma³

2018

Anesth Essays Res

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Bilateral TMJ Ankylosis with limited mouth opening in pediatric patients: An anesthetic challenge

Varghese,

Muniyappa,

Harsoor

et al. 2024

Saudi Journal of Anaesthesia

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Restricted mouth opening is a challenging airway in pediatric patients with temperomandibular joint (TMJ) ankylosis. The fiber-optic bronchoscopic nasotracheal intubation technique continues to be the gold standard for difficult airway, among the techniques available such as submandibular intubation, retrograde intubation, and tracheostomy. However, awake fiber-optic bronchoscopy (FOB) is difficult to achieve in pediatric patients. Prior planning of the anesthetic method and effective collaboration with the surgeon are crucial for excellent outcomes in such challenging airway cases. We present a successful awake fiber-optic bronchoscopy with high-flow nasal oxygen (HFNO), airway blocks, and deep sedation in the case of bilateral TMJ ankylosis of a pediatric age group with reduced mouth opening. We conclude that awake intubation using HFNO and airway blocks helps to achieve oxygenation and ease of intubation in difficult airway management.

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Nasal fiberoptic intubation: A savior during handling a pediatric difficult airway

Cited by 2 publications

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Temporomandibular joint ankylosis: “A pediatric difficult airway management”

Temporomandibular joint ankylosis: “A pediatric difficult airway management”

Bilateral TMJ Ankylosis with limited mouth opening in pediatric patients: An anesthetic challenge

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