Airway topical anesthesia using a rigid fiberoptic stylet in children with difficult airways

Review Airway management in pediatric patients with burn contractures of the face and neck

Burn injury is a common cause of trauma, non-fatal burn injuries are a leading cause of morbidity, and significant numbers of the victims are children. Scar contracture after burn injury can cause severe functional limitation, pain, aesthetic and psychological problems and patients may present for contracture release and reconstructive surgery. The aim of this systematic review was to identify research relevant to airway management of children with burn contracture of the face and neck with special emphasis on awake airway management and airway anesthesia, and synthesize results that can aid practice. Literature search was performed on Medline, PubMed, Cochrane Library, and Google Scholar with selected keywords. The search was restricted to human subjects of ≤18 year age, there was no language or time restriction and the final search was concluded in July 2021. The review included 41 articles involving airway management of 56 patients in 61 anesthesia episodes. Patients aged between 8 months to 18 years. Mask ventilation and direct laryngoscopy, video laryngoscopy, optical stylet, supraglottic airway, flexible scope intubation and tracheostomy, and extracorporeal membrane oxygenation were the devices and methods used for securing the airway and oxygenation while the patients were awake or after anesthesia induction. Detailed planning and patient preparation are the fundamentals of airway management of pediatric patients with burn contracture of the face and neck, awake airway management with airway anesthesia can be safely used in selected patients, this review provides information for good clinical practice and might serve to improve the care of such children.

A novel modified method of using Trachway intubating stylet for awake tracheal intubation in patients with anticipated difficult airway

The Trachway intubating stylet is designed to facilitate tracheal intubation in anesthetized patients with a normal or difficult airway anatomy. The shortcoming of this device is the lack of a working channel to provide topicalization of the airway. We describe a novel modified method of using Trachway intubating stylet to provide airway topicalization and perform awake orotracheal intubation in two cases with an anticipated difficult airway. The first case was a superobese patient with a cervical spine disorder, whereas the second case was a patient with an enlarged thyroid gland. Transtracheal lidocaine injection was technically difficult in these patients because of neck obesity and thyroid enlargement, respectively. We believe that this modified method can be used to provide effective airway topicalization when Trachway intubating stylet is used for awake orotracheal intubation.