Guidelines for Elective Pediatric Fiberoptic Intubation

Summary

We describe guidelines to perform a safe and efficient elective fiberoptic intubation in pediatric patients while maintaining spontaneous ventilation.

Abstract

Fiberoptic intubation in pediatric patients is often required especially in difficult airways of syndromic patients i.e. Pierre Robin Syndrome. Small babies will desaturate very quickly if ventilation is interrupted mainly to high metabolic rate. We describe guidelines to perform a safe fiberoptic intubation while maintaining spontaneous breathing throughout the procedure. Steps requiring the use of propofol pump, fentanyl, glycopyrrolate, red rubber catheter, metal insuflation hook, afrin, lubricant and lidocaine spray are shown.

Protocol

1. Equipment Preparation

1. Med fusion pump for propofol infusion
2. Place nasotracheal tubes under heating mattress
3. Connect camera to scope and check orientation
4. Three movements affect the view through the scope:
   1. In and out.
   2. Rotation using a two-handed maneuver.
   3. Flexion and extension of the tip of the scope.

2. Additional Equipment

1. Fentanyl 0.5-1.0 mcg/kg
2. 12F red rubber suction catheter
3. Glycopyrrolate 0.1-0.2 mg
4. Metal insufflation hook
5. Afrin nasal spray
6. Lubrican....

Discussion

Fiberoptic intubation in pediatric patients with difficult airway could be a challenging task^1,2 and the presence of craniofacial dysmorphisms presents additional challenges to tracheal intubation³. It is more difficult to perform this procedure in pediatric patients than in adults mainly because of smaller airways in pediatric patients which make the manipulation of the fiberoptic more difficult since any small movement of the tip of the firberoptic scope runs the risk of touching the mucosa of the.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Med fusion pump for propofol infusion
Fentanyl 0.5-1.0 mcg/kg
12F red rubber suction catheter
Glycopyrrolate 0.1-0.2 mg
Metal insufflation hook
Afrin nasal spray
Lubricant
Lidocaine 2% or 4% for spraying nares