Use of angulated video-intubation laryngoscope in children undergoing manual in-line neck stabilization

Abstract

Laryngeal views obtained during direct laryngoscopy with and without manual in-line neck stabilization (MILNS) and during video-assisted intubation with MILNS using the angulated video-intubation laryngoscope were assessed in 100 paediatric patients (aged 0.25-17.3 yr). Visualization of the larynx (Cormack and Lehane score) as well as time taken for video-assisted tracheal intubation by six nurses and four resident anaesthetists not experienced in the technique were recorded. Cormack and Lehane scores were significantly worse during direct laryngoscopy when MILNS was applied. Video-assisted visualization of the larynx during MILNS produced scores, which were as good or better than those observed during direct laryngoscopy alone. Intubation times ranged from 19-75 s (mean 35 (SD 13.4); median 32).

Tracheal intubation in children with Morquio syndrome using the angulated video-intubation laryngoscope

“…Our previous experience with the AVIL in children, prompted us to use the AVIL as a standby device for rapid endoscopic intubation assistance if the MAIS procedure should impair visibility of the vocal cords during direct laryngoscopy. 6 Both patients were rapidly and uneventfully intubated within the following intubation attempt.…”

“…Direct laryngoscopy with MAIS is an often successful and therefore a suitable approach in these circumstances. 6 In conditions of known or suspected instability of the cervical spine, intubation should be accomplished with as little movement of the cervical spine as possible. Flexible fibreoptic tracheal intubation or another technique that minimizes cervical spine movements should be the standard of care.…”

“…5,19,20 However, direct laryngoscopy can be more difficult under MAIS and forced laryngeal or cricoid pressure can cause movements of the cervical spine during intubation. [6][7][8] If difficulties with direct visualization of the vocal cords occur, anesthesiologists often rely on blind tracheal intubation using a styletted ET or a gum-elastic bougie. 2 0 Other possibilities include the Bullard Laryngoscope 2 1 and fibreoptic intubation using the laryngeal mask airway, 2 2 among many others.…”

“…The AVIL has been used successfully in children aged from 0.25-17.3 yr with simulated difficult intubations by residents and nurse anesthetists not experienced with fibreoptic intubation. 6 We report the successful use of the AVIL for tracheal intubation in two of three sisters with Morquio's syndrome scheduled for adenotomy the same day in whom MAIS impaired direct laryngoscopy.…”

“…1 0 In contrast to the McCoy blade, which can improve direct glottic visualization, the AVIL has been particularly designed to give an improved glottic view on a video-monitor during difficult tracheal intubation, similar to the angulated prism laryngoscope. 6,10,11 The AVIL is used to elevate the tongue or, if required, to lift up the epiglottis to provide a full view of the vocal cords. Once the cords are visualized on the bedside video screen, the endotracheal tube (ET), styletted and bent to form a hockey stick, is guided under direct vision along the vertical flange of the blade to the distal blade tip and then guided through the vocal cords under monitor control.…”