Video-intuboscopic monitoring of tracheal intubation in pediatric patients

Purpose: To evaluate the efficacy of video-intuboscopic monitoring during o rotracheal intubation in a pediatric anesthesia teaching unit. Methods: In 100 pediatric patients direct laryngoscopy performed by residen ts or nurse anesthetists was monitored on a video display using a flexible, ultralight video-endoscopic system (O.D, 2.8 mm / length 1.8 m) within the endotracheal tube (ETT). Best direct laryngoscopic view was assessed by th e intubator. The instructor observed the intubation procedure on the video display and noted number of intubation attempts, best laryngoscopic monitor view, tube passage through the larynx and final tube position. If required he gave instructions or corrections. After removal of the laryngoscope, tr acheal tube position was adjusted using the monitor view. Difficulties attr ibuted to the fibreoptic endoscope during intubation and removal from the E TT were recorded. Results: The trachea was successfully intubated at the first attempt in all patients, The supervisor detected one esophageal and 12 endobronchial intu bations that were immediately corrected before starting ventilation, Final visualized endotracheal tube adjustment above the carina was possible in al l patients except in one with copious tracheal secretions. Compared with di rect laryngoscopy the video display provided an improved view of the vocal cords during intubation, In six patients direct laryngoscopy was difficult but the tracheas were intubated using the monitor view. No difficulties wit h the equipment were encountered except that the black coated endoscope com promised recognition of the black ETT depth-markings in small tubes. Conclusions: Video-intuboscopic monitoring is a useful monitor of tracheal intubation. The improved view of the cords may provide assistance during di fficult laryngoscopy.