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Tracheal intubation in children with Morquio syndrome using the angulated video-intubation laryngoscope

[L'intubation endotrachéale chez des enfants, atteints de la maladie de Morquio, à l'aide du laryngoscope angulaire pour intubation vidéo]

Alexander Dullenkopf, MD^*, David Holzmann, MD, Rita Feurer, RN^*, Andreas Gerber, MD^* and Markus Weiss, MD^*

^* From the Department of Anaesthesia, University Children's Hospital, and
the Department of Otorhinolaryngology, University Hospital, Zurich, Switzerland.

Address correspondence to: Dr. Markus Weiss, Department of Anaesthesia, University Children's Hospital, Steinwiesstrasse 75, 8032 Zurich, Switzerland. Phone: +41 1 266 77 53; Fax: +41 1 266 71 68; E-mail: markus.weiss{at}kispi.unizh.ch

Purpose: There are a number of syndromes with proven or suspected instability of the cervical spine especially in pediatric patients. It is a challenge for the anesthesiologist to intubate these patients with as little movement of the cervical spine as possible. A new device to facilitate this task is the angulated video-intubation laryngoscope (AVIL).

Clinical features: The AVIL is a curved endoscopic intubation laryngoscope with angulated distal tip. The video-view from the distal blade tip improves glottic visualization during difficult direct laryngoscopy. We report three sisters with Morquio syndrome scheduled for otorhinolaryngology surgery the same day. Two of them had radiologically suspected cervical spine instability. Tracheal intubation was planned with careful direct laryngoscopy under manual in-line stabilization of the neck and head by an assistant. Direct visualization of the larynx using a Miller blade No. 2 was impaired in two of the three children in whom the cervical spine was immobilized. They were both successfully intubated under endoscopic control using the AVIL.

Conclusion: The AVIL may become a helpful device to aid endotracheal intubation in patients when cervical spine immobilization impairs direct laryngoscopy.

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