A COMPARISON OF AWAKE VERSUS PARALYZED TRACHEAL INTUBATION FOR INFANTS WITH PYLORIC-STENOSIS

This prospective, nonrandomized, observational study of 76 infants wit h pyloric stenosis was conducted at an academic children's hospital an d compared awake versus paralyzed tracheal intubation in terms of succ essful first attempt rate, intubation time, heart rate (HR) and arteri al hemoglobin oxygen saturation (Spo(2)) changes, and complications. T hree groups were determined by intubation method: awake (A) with an ox ygen-insufflating laryngoscope, after rapid-sequence induction (R), or after modified rapid-sequence induction (M) including ventilation thr ough cricoid pressure. Successful first attempt intubation rate was 64 % for Group A versus 87% for paralyzed Groups R and M (P = 0.028). Med ian intubation time was 63 s in Group A versus 34 s in Groups R and M (P = 0.004). Transient, mild decreases in mean HR and Spo(2) and incid ences of significant bradycardia and decreased Spo(2) did not vary by group. Complications, including bronchial or esophageal intubation, em esis, and oropharyngeal trauma, were few. Senior anesthesiologists int ervened in four tracheal intubations. We advocate anesthetized, paraly zed tracheal intubation because struggling with conscious infants take s longer, often requires multiple attempts, and prevents neither brady cardia nor decreased Spo(2). After induction, additional mask ventilat ion with O-2 confers no advantage over immediate tracheal intubation i n preserving Spo(2). Implications: In our children's hospital, awake t racheal intubation was not superior to anesthetized, paralyzed intubat ion in maintaining adequate oxygenation and heart rate or in reducing complications, and should be abandoned in favor of the latter techniqu e for routine anesthetic management of otherwise healthy infants with pyloric stenosis.