Fibreoptic nasal intubation in children with anticipated and unanticipateddifficult intubation

The establishment of a tracheal airway with direct laryngoscopy can be eith er a very difficult or an impossible task in children with congenital or ac quired facial malformations. Out of 46 patients categorized as difficult tr acheal intubation, fibreoptic laryngoscopy was used successfully in 44 chil dren anaesthetized by mask with sevoflurane and oxygen or by an intravenous infusion of propofol and mask oxygenation. There were two failures (4.3%). One was due to excessive bleeding and secretions produced by the multiple attempts to intubate with direct laryngoscopy and the other failure in a pa tient with Pierre Robin syndrome and very small nasal passages that preclud ed the introduction of the endoscope. Fibreoptic laryngoscopy was successfu l in 37 cases (80.4%) on the first attempt to intubate and in seven (15.2%) on a second or third attempt. We conclude that fibreoptic laryngoscopy in anaesthetized children with difficult anticipated or unanticipated tracheal intubation in trained hands is a safe technique that can be lifesaving. Th erefore, we urge all anaesthesia trainees to become proficient in fibreopti c tracheal intubation.