CASE REPORT
Year : 2011  |  Volume : 5  |  Issue : 4  |  Page : 414-416

Intubation in a pediatric difficult airway using an adult flexible fiber-optic bronchoscope and a j-tipped guidewire: An innovation in adversity


1 Department of Anaesthesiology, Maulana Azad Institute of Dental Sciences, New Delhi, India
2 Department of Oral & Maxillofacial Surgery, Maulana Azad Institute of Dental Sciences, New Delhi, India

Correspondence Address:
Manish Naithani
D 126, Surajmal Vihar, Teacher's Colony, Delhi 110 092
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1658-354X.87272

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Management of an anticipated difficult airway relies heavily on flexible fiber-optic bronchoscope (FFB) guided awake intubations. In a pediatric patient with difficult airway, doing an awake procedure may be difficult, and hence the child is either deeply sedated or anesthesia is induced before attempting intubation with an appropriate sized FFB. We present the anesthetic management of a 6-year-old child with a lacerated tongue and fractured mandibular condyle, with subsequent inability to open his mouth, who was posted for urgent exploration and open reduction under anesthesia. Unhindered by a damaged pediatric FFB, we innovated by positioning the tip of an adult FFB just outside the larynx, passing a j-tipped guidewire through the working channel of the FFB, and successfully railroaded a naso-tracheal tube over the guidewire. The surgery, reversal and extubation, and the postoperative period were uneventful.


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