Korean J Anesthesiol.  2001 Feb;40(2):261-264. 10.4097/kjae.2001.40.2.261.

The Two Step Fiberoptic Approach in the Management of a Difficult Pediatric Airway due to a Vallecular Cyst

• Kim SH
• Park WK
• Choi HS
• Oh KM
• Hong SJ

• KMID: 2236832
• DOI: http://doi.org/10.4097/kjae.2001.40.2.261

Abstract

A 6-yr-old male weighing 20 kg with the diagnosis of a large vallecular cyst in the oropharynx was scheduled for surgical excision. After a slight loss of consciousness following an IV injection of ketamine 10 mg while maintaining spontaneous respiration, 4% lidocaine was sprayed into the right nostril. An uncuffed 4 mm OD wire-reinforced endotracheal tube was advanced through the right nostril and positioned in the nasopharynx. An ultrathin 60 cm Olympus LF-P fiberoptic bronchoscope (OD: 2.2 mm) was threaded and the vocal cords and surrounding structures were identified as intact. The endotracheal tube and fiberscope were withdrawn. Ketamine 10 mg was injected intravenously again. Following direct insertion of an Olympus fiberoptic bronchoscope (OD: 3.8 mm) through the right nostril without tube placement and visualization of the vocal cords, topical anesthesia of the larynx was achieved by spraying 1 ml 2% lidocaine through the biopsy channel. Thirty seconds later, it was passed into the trachea and 1 ml 2% lidocaine was sprayed intratracheally. The bronchoscope was withdrawn. The 4 mm uncuffed wire-reinforced tube was passed again through the right nostril and an ultrathin fiberoptic bronchoscope (OD: 2.2 mm) was threaded over the tube, and passed smoothly without resistance. There was neither laryngeal spasm nor cough. Anesthesia was maintained with enflurane 2.0 vol%, N2O (1.5 L/min) and O2 (1.5 L/min). The mass was successfully excised and extubated without compromise. The patient was uneventfully discharged the next day.

Keyword

Anesthetics, intravenous: ketamine; Anesthetic techniques: pediatric fiberoptic intubation; Intubation, tracheal: difficult

MeSH Terms

Anesthesia
Biopsy
Bronchoscopes
Cough
Diagnosis
Enflurane
Humans
Ketamine
Laryngismus
Larynx
Lidocaine
Male
Nasopharynx
Oropharynx
Respiration
Trachea
Unconsciousness
Vocal Cords
Enflurane
Ketamine
Lidocaine