Fiberoptic Nasotracheal Intubation in Pediatric Patients with Difficult Mouth Opening: A case report.

Lee,  Woo Chang; Koo,  Bon Nyeo; Kim,  Ki Jun; Min,  Kyeong Tae; Park,  Wyun Kon; Park,  Hyung Sik; Lew,  Dae Hyun

doi:2002.43.6.795

Case Report

Korean Journal of Anesthesiology 2002;43(6):795-799.
DOI: https://doi.org/10.4097/kjae.2002.43.6.795

Fiberoptic Nasotracheal Intubation in Pediatric Patients with Difficult Mouth Opening: A case report.

Woo Chang Lee, Bon Nyeo Koo, Ki Jun Kim, Kyeong Tae Min, Wyun Kon Park, Hyung Sik Park, Dae Hyun Lew

¹Department of Anesthesiology, Yonsei University College of Medicine, Seoul, Korea. wkp7ark@yumc.yonsei.ac.kr
²Department of Oral and Maxillofacial Surgery, Yonsei University College of Medicine, Seoul, Korea.
³Department of Plastic and Reconstructive Surgery, Yonsei University College of Medicine, Seoul, Korea.

Abstract

We present two pediatric patients, one with Pierre Robin syndrome and one with temporomandibular joint ankylosis with limited mouth opening. They had historical and physical evidence of airway obstruction, difficult feeding, and sleep disturbance. They were scheduled for oromaxillofacial surgery. In each case, two different-sized fiberoptic bronchoscopes were used for nasotracheal intubation. After loss of consciousness following an IV injection of ketamine or inhalation of sevoflurane while maintaining spontaneous respiration, 10% lidocaine was sprayed into one nostril. Following insertion of a 60 cm Olympus LF-2 fiberoptic bronchoscope (OD: 3.8 mm) through the same nostril without tube placement, the vocal cords were visualized and topical anesthesia of the larynx was achieved by spraying 2% lidocaine through the biopsy channel. Thirty seconds later, the bronchoscope was passed into the trachea and 2% lidocaine was sprayed intratracheally. Then, the bronchoscope was withdrawn. An endotracheal tube was advanced through the same nostril and positioned in the nasopharynx and the ultrathin fiberoptic bronchoscope (OD: 2.2 mm) was threaded through the tube. There was neither a cough nor laryngeal spasm during advancement of the tube into the trachea. Extubation was performed without compromise in the operating room. The patients were discharged uneventfully.

Key Words: Fiberoptic intubation; ketamine; Pierre Robin syndrome; sevoflurane; temporomandibular joint ankylosis