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Video-intuboscopic assistance is a useful aid to tracheal intubation in pediatric patients

[L'assistance vidéoscopique facilite l'intubation endotrachéale des patients pédiatriques]

Markus Weiss^*,, Kirsten Hartmann^*, Joachim Fischer and Andreas C. Gerber^*

^* From the Departments of Anaesthesia and Intensive Care and Neonatology,
University Children's Hospital, Zurich, Switzerland.

Address Correspondence to : Dr. Markus Weiss, Department of Anaesthesia, University Children's Hospital, Steinwiesstrase 75, Zurich, Switzerland. Phone: +41 1 266 71 11; Fax +41 1 266 71 68; E-mail: markus.weiss{at}kispi.unizh.ch

Purpose: To evaluate the efficacy of video-intuboscopic assisted tracheal intubation in a difficult intubation setting.

Methods: In 50 pediatric patients (mean age 12.8 ± 3.1 yr, range 6–16 yr) a grade 3 direct laryngoscopic view was simulated. Eight certified registered nurse anesthetists without experience in endoscopic intubation performed tracheal intubation on five or more patients using the video-optical intubation stylet. Time from insertion of the tube into the oral cavity until the tip had passed the vocal cords was recorded. Failed intubation was defined as intubation >60 sec, arterial oxygen saturation <92% or esophageal intubation. Subjective degree of difficulty was asked from the operators using a Likert-scale.

Results: Forty-six of the 50 patients were successfully intubated within 60 sec and without arterial oxygen desaturation. In four patients, video-assisted tracheal intubation failed due to prolonged intubation time. Intubation times ranged from 10–40 sec (median 15 sec). Mean intubation time in the first patient (24.5 ± 17.3 sec) appeared longer than for the fifth patient (20.8 ± 10.9 sec), but the difference was not statistically significant (P=0.87). Mean estimated degree of difficulty was 3.9 ± 2.1. Subjective estimates of difficulty increased with intubation times (P=0.001).

Conclusion: The video-optical intubation stylet can be considered a valuable aid for tracheal intubation in pediatric patients with a difficult airway.

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