Glossopexy in Pierre Robin sequence using the laryngeal mask airway

Alternative ventilation strategies: laryngeal masks

The appropriate role for laryngeal masks during delivery room resuscitation has not been established. The authors systematically reviewed the literature to answer three clinical questions: (1) In newborns requiring positive-pressure ventilation for resuscitation, would a laryngeal mask achieve safe and effective ventilation faster than facemask ventilation? (2) In newborns unable to be ventilated effectively with a facemask during resuscitation, would a laryngeal mask achieve effective ventilation faster than endotracheal intubation? (3) In newborns requiring resuscitation, would a laryngeal mask achieve effective ventilation when facemask ventilation and endotracheal intubation have been unsuccessful?

Flexible lightwand-guided intubation using the intubating laryngeal mask airway in the supine, right, and left lateral positions in healthy patients by experienced users

IMPLICATIONS

Flexible lightwand-guided intubation with the intubating laryngeal mask airway is equally effective in the supine, right, and left lateral positions in healthy patients by experienced users.

Oesophageal perforation presenting as oesophageal atresia in a premature neonate following difficult intubation

Iatrogenic oesophageal perforation in neonates is well recognized in the medical and surgical literature with intubation injury listed as a possible contributing mechanism besides nasogastric tube placement and suctioning. Diagnosis can be difficult and sometimes confused with other entities. With early diagnosis, nonsurgical management often leads to complete resolution in neonates. We report the case of a 1-day-old premature neonate who was brought to the operating room with the preliminary diagnosis of proximal oesophageal atresia with stump perforation and distal tracheo-esophageal fistula. His intubation for respiratory distress at birth had been difficult due to Pierre-Robin sequence with micrognathia. Oesophagoscopy in the operating room revealed a patent oesophagus but perforations in the pharynx and in the proximal oesophagus with the nasogastric tube entering the pharyngeal perforation. Oesophageal perforation and the limitations of the difficult airway algorithm in small neonates are discussed.

The laryngeal mask airway: potential applications in neonatal health care

The laryngeal mask airway is a completely new concept in airway management and has the potential to provide a third airway option for the neonate. The device sits in the hypopharynx at the interface between the gastrointestinal and respiratory tracts, where it forms a circumferential low-pressure seal around the glottis. This article provides an overview of the laryngeal mask airway and focuses on its potential as a neonatal airway outside the operating room.