Name: guidelines for elective pediatric fiberoptic intubation
Uploaded: 2011-01-17T19:00:00
Description: Watch this Scientific Journal Video about Guidelines for Elective Pediatric Fiberoptic Intubation at JoVE.com

This work is funded by the department of anesthesiology at children's hospital of Michigan.

1. Equipment Preparation
<ol>
	<li>Med fusion pump for propofol infusion</li>
	<li>Place nasotracheal tubes under heating mattress</li>
	<li>Connect camera to scope and check orientation</li>
	<li>Three movements affect the view through the scope:
		<ol>
			<li>In and out.</li>
			<li>Rotation using a two-handed maneuver.</li>
			<li>Flexion and extension of the tip of the scope.</li>
		</ol>
	</li>
</ol>
2. Additional Equipment
<ol>
	<li>Fentanyl 0.5-1.0 mcg/kg </li>
	<li>12F ...

<ol>
	<li>Kinouchi, K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Management+of+difficult+pediatric+airway.">Management of difficult pediatric airway.</a> Masui. 55, 24-32 (2006).</li><li>Chen, Y. L., Wu, K. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Airway+management+of+patients+with+craniofacial+abnormalities:+10-year+experience+at+a+teaching+hospital+in+Taiwan.">Airway management of patients with craniofacial abnormalities: 10-year experience at a teaching hospital in Taiwan.</a> J Chin Med Assoc. 72, 468-470 (2009).</li><li>. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Practice+guidelines+for+management+of+the+difficult+airway:+an+updated+report+by+the+American+Society+of+Anesthesiologists+Task+Force+on+Management+of+the+Difficult+Airway.">Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway.</a> Anesthesiology. 98, 1269-1277 (2003).</li><li>Fiadjoe, J., Stricker, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pediatric+difficult+airway+management:+current+devices+and+techniques.">Pediatric difficult airway management: current devices and techniques.</a> Anesthesiol Clin. 27, 185-195 (2009).</li><li>Wheeler, M., Roth, A. G., Dsida, R. M., Rae, B., Seshadri, R., Sullivan, C. L., Heffner, C. L., Cote, C. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Teaching+residents+pediatric+fiberoptic+intubation+of+the+trachea:+traditional+fiberscope+with+an+eyepiece+versus+a+video-assisted+technique+using+a+fiberscope+with+an+integrated+camera.">Teaching residents pediatric fiberoptic intubation of the trachea: traditional fiberscope with an eyepiece versus a video-assisted technique using a fiberscope with an integrated camera.</a> Anesthesiology. 101, 842-846 (2004).</li><li>Roth, A. G., Wheeler, M., Stevenson, G. W., Hall, S. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparison+of+a+rigid+laryngoscope+with+the+ultrathin+fibreoptic+laryngoscope+for+tracheal+intubation+in+infants.">Comparison of a rigid laryngoscope with the ultrathin fibreoptic laryngoscope for tracheal intubation in infants.</a> Can J Anaesth. 41, 1069-1073 (1994).</li><li>Ovassapian, A., Dykes, M. H., Golmon, M. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+training+programme+for+fibreoptic+nasotracheal+intubation.+Use+of+model+and+live+patients.">A training programme for fibreoptic nasotracheal intubation. Use of model and live patients.</a> Anaesthesia. 38, 795-798 (1983).</li><li>Stevenson, G. W., Roth, A. G., Wheeler, M., Hall, S. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Use+of+the+Olympus+LF-P+fibreoptic+laryngoscope+by+trainees+in+paediatric+anaesthesia.">Use of the Olympus LF-P fibreoptic laryngoscope by trainees in paediatric anaesthesia.</a> Anaesthesia. 51, (1996).</li><li>Taguchi, S., Kusunoki, S., Fukuda, H., Hamada, H., Kawamoto, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Difficult+tracheal+intubation+using+airway+scope+in+a+pediatric+patient+with+Hunter+syndrome.">Difficult tracheal intubation using airway scope in a pediatric patient with Hunter syndrome.</a> Masui. 58, 1278-1281 (2009).</li></ol>

Fiberoptic intubation in pediatric patients with difficult airway could be a challenging task1,2 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...

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

guidelines for elective pediatric fiberoptic intubation

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.

Watch this Scientific Journal Video about Guidelines for Elective Pediatric Fiberoptic Intubation at JoVE.com

Guidelines for Elective Pediatric Fiberoptic Intubation

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

Fiberoptic intubation in pediatric patients is often required especially in difficult airways of syndromic patients i.e. Pierre Robin Syndrome. Small ...

Research

JoVE Journal

Medicine

A Novel Rescue Technique for Difficult Intubation and Difficult Ventilation

We describe a novel non surgical technique to maintain oxygenation and ventilation in a case of difficult intubation and difficult ventilation, which ...

Endotracheal Intubation in Mice via Direct Laryngoscopy Using an Otoscope

Endotracheal Intubation in Mice via Direct Laryngoscopy Using an Otoscope

Endotracheal i mus<em&gt; Via</em&gt; Direkte laryngoskopi Brug af en otoskop

Mice, both wildtype and transgenic, are the principal mammalian model in biomedical research currently. Intubation and mechanical ventilation are ...

Cell Population Analyses During Skin Carcinogenesis

Cellepopulation Analyser Under hudkræft

Cancer development is  a multiple-step process involving many cell types including cancer precursor  cells, immune cells, fibroblasts and endothelial ...

A Simple Method of Mouse Lung Intubation

En simpel metode til Mouse Lung Intubation

A  simple procedure to intubate mice for pulmonary function measurements would  have several advantages in longitudinal studies with limited numbers or  ...

Noninvasive Intratracheal Intubation to Study the Pathology and Physiology of Mouse Lung

Noninvasiv Intratracheal Intubation til at studere Patologi og fysiologi Mouse Lung

The use of a model that mimics the condition of lung diseases in humans is critical for studying the pathophysiology and/or etiology of a particular ...

Intubation-mediated Intratracheal (IMIT) Instillation: A Noninvasive, Lung-specific Delivery System

Intubation-mediated Intratracheal IMIT Instillation: A Noninvasive, Lung-specific Delivery System

Intubation-medieret Intratracheal (IMIT) Instillation: en noninvasiv, Lunge-specifik Delivery System

Respiratory disease studies typically involve the use of murine models as surrogate systems. However, there are significant physiologic differences ...

An Improved Method for Rapid Intubation of the Trachea in Mice

En forbedret fremgangsmåde til hurtig intubation af trachea i mus

Despite some anatomical and physiological differences, mouse models continue to be an essential tool for studying human lung disease. Bleomycin toxicity ...

Interictal High Frequency Oscillations Detected with Simultaneous Magnetoencephalography and Electroencephalography as Biomarker of Pediatric Epilepsy

Interictal højfrekvente Svingninger Registrerede med Samtidig magnetoencephalography og Elektroencefalografi som biomarkør for Pediatric Epilepsi

Crucial to the success of epilepsy surgery is the availability of a robust biomarker that identifies the Epileptogenic Zone (EZ). High Frequency ...

Topical Airway Anesthesia for Awake-endoscopic Intubation Using the Spray-as-you-go Technique with High Oxygen Flow

Aktuel Airway Anæstesi til Awake-endoskopisk Intubation Brug af Spray-as-you-go teknik med høj Oxygen Flow

A patient&#39;s willingness to cooperate is an absolute precondition for successful awake intubation of the trachea. Whilst drug-sedation of patients can ...

Protocol and Guidelines for Point-of-Care Lung Ultrasound in Diagnosing Neonatal Pulmonary Diseases Based on International Expert Consensus

Protokol og retningslinjer for punkt af pleje lunge ultralyd til at diagnosticere Neonatal lungesygdomme baseret på internationale ekspert konsensus

Ultrasound is a safe bedside imaging tool that obviates the use of ionizing radiation diagnostic procedures. Due to its convenience, the lung ultrasound ...