PEDIATRIC FLEXIBLE FIBEROPTIC BRONCHOSCOPY THROUGH THE LARYNGEAL MASKAIRWAY

Objective: To determine the usefulness and safety of the laryngeal mas k airway (LMA) as an adjunct to pediatric flexible fiberoptic bronchos copy (FOB). Design: A case-series retrospective study. Setting: Pediat ric otolaryngology tertiary referral center, outpatient and inpatient operating suites. Patients: Retrospective review of charts of children who had FOB performed with the use of LMA by the pediatric otolaryngo logy service. The patients were ages 3 months to 18 years with respira tory symptoms requiring FOB for diagnosis.Interventions: Use of LMA to support airway during FOB with spontaneous ventilation with the patie nts under general anesthesia. Main Outcome Measures. Ability to perfor m airway evaluation with FOB and LMA; number and type of complications . Results: Seventeen patients, ages 3 months to 18 years (median age, 39 months) underwent FOB with use of LMA. In 2 patients use of LMA fai led-1 from airway obstruction with LMA in place, which required intuba tion, and another who could not have LMA appropriately placed. Fifteen patients underwent uncomplicated FOB through the LIVIA. None of these 15 patients required unplanned endotracheal intubation. Two patients with mandibular hypoplasia required LMA use for airway evaluation when the glottis could not be visualized at direct laryngoscopy. Conclusio ns: The LMA is a safe and effective adjunct to pediatric FOB. Laryngea l mask airway use for FOB allows evaluation of the airway during spont aneous ventilation without an endotracheal tube or a face mask. Larger fiberoptic scopes fan be used through the LMA compared with pediatric FOB performed through the nose or through an endotracheal tube.