The use of the laryngeal mask airway in children with subglottic stenosis

Anaesthesia Management During Interventional Bronchoscopic Procedures: Laryngeal Mask Airway or Rigid Bronchoscope

OBJECTIVE

Interventional bronchoscopy procedures are novel and effective modes of diagnosing and treating airway lesions. Airway management and ventilation are a major concern, especially when considering the fire hazard of ventilating during endobronchial thermal therapies. The aim of this study was to evaluate the usage of laryngeal mask airway (LMA) compared to rigid bronchoscopy for the ventilation of patients undergoing diagnostic or therapeutic interventional bronchoscopy procedures.

METHODS

During this prospective randomised clinical trial study, patients were randomly allocated to two groups for ventilation: LMA and rigid bronchoscopy. Vital signs, including blood pressure, heart rate and percentage of blood O2 saturation before and during the procedure, degree of sore throat after recovery and physician's satisfaction, were recorded.

RESULTS

A total of 83 patients, including 45 in the "LMA" and 38 in the "rigid" groups, were enrolled in this study. Their mean age was 51±17 years, and 59 (71%) were male. There was a statically significant difference between "rigid" and "LMA" categories regarding the decrease in O2 during the procedure in proportion to baseline figures (p=0.028). Haemodynamic parameters were better maintained using LMA compared to rigid bronchoscopy.

CONCLUSION

Laryngeal mask ventilation maintains better oxygenation and haemodynamic stability and ensures physicians' and patients' satisfaction regarding ease of use, airway access and fewer complications compared to rigid bronchoscopy. Therefore, LMA can be introduced as a reliable alternative for ventilation during interventional airway procedures.

Idiopathic subglottic stenosis in pregnancy: A deceptive laryngoscopic view

A 28-year-old lady with term gestation, pre-eclampsia and a vague history of occasional breathing difficulty, on irregular bronchodilator therapy, was scheduled for category 1 lower segment caesarean section in view of foetal distress. A Cormack-Lehane grade 1 direct laryngoscopic view was obtained following rapid sequence induction. However, it was not possible to insert a 7.0 or 6.0 size styleted cuffed tracheal tube in two attempts. Ventilation with a supraglottic device was inadequate. Airway was secured with a 4.0 size microlaryngeal surgery tube with difficulty. Computed tomography scan of the neck following tracheostomy for failed extubation revealed subglottic stenosis (SGS) with asymmetric arytenoid calcification. This report describes the management of a rare case of unrecognised idiopathic SGS in pregnancy.

Airway exchange catheters use in the airway management of neonates and infants undergoing surgical treatment of laryngeal stenosis

BACKGROUND

Congenital and acquired upper airway obstruction in infants commonly manifests as an acute, potentially life-threatening condition or a slow and gradual deterioration and can be a challenge to the pediatric anesthesiologist. This case series reports the nonconventional use of pediatric airway exchange catheters emergent and short-term airway management and lung ventilation in neonates and infants with severe laryngotracheal stenosis.

CASE SERIES

After the approval of local Institutional Review Board, 11 consecutive patients presenting with severe laryngotracheal stenosis exceeding 70% were prospectively studied. Median (range) age and weight were 32 days (0-96) and 2.7 kg (2.1-3.4), respectively. Induction of anesthesia consisted of sevoflurane 5% in oxygen followed by sevoflurane 3% in an air/oxygen mixture (Fio2 = 0.5). Spontaneous ventilation was maintained in all patients. The trachea was intubated using an Airway Exchange Catheter with an inner diameter of 1.6 mm (Cook Airway Exchange Catheters, Cook Medical, Bloomington, IN). An Airway Exchange Catheter was inserted through the stenosis and manually assisted ventilation was confirmed using capnography. Median (range) ventilation duration was 28 minutes (12-61 mins). In one neonate, the Airway Exchange Catheter failed to ensure proper ventilation and an emergency tracheostomy was performed. Respiratory distress was likely due to a significant increase in airway resistance at the stenosis level or distal accumulation of secretions.

CONCLUSION

Airway exchange catheters represent a useful additional tool for short-term advanced airway management for both oxygenation and ventilation in neonates and infants presenting with severe laryngotracheal stenosis.