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Successful Tracheal Intubation through an Intubating Laryngeal Airway in Pediatric Patients with Airway Hemorrhage

  • Narasimhan Jagannathan
    Correspondence
    Reprint Address: Narasimhan Jagannathan, MD, Department of Pediatric Anesthesiology, Children’s Memorial Hospital, Northwestern University’s Feinberg School of Medicine, 2300 Children’s Plaza, Chicago, IL 60614
    Affiliations
    Department of Pediatric Anesthesiology, Children’s Memorial Hospital, Northwestern University’s Feinberg School of Medicine, Chicago, Illinois
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  • David T. Wong
    Affiliations
    Department of Anesthesia, Toronto Western Hospital, University of Toronto, Toronto, Ontario
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      Abstract

      Background

      This case report describes the use of the air-Q intubating laryngeal airway (air-Q ILA; Cookgas LLC, St. Louis, MO) for airway rescue and a conduit for blind tracheal intubation in two pediatric patients with failed rapid sequence intubation and difficult airways secondary to airway bleeding in the emergency department (ED).

      Objectives

      To describe the use of a new supraglottic rescue device in the management of the pediatric patient’s difficult airway in the emergency setting.

      Case Report

      Case 1 was a 5-year-old boy who presented to the ED for bleeding one day after his tonsillectomy. After a rapid sequence intubation, direct laryngoscopy was difficult, with copious bleeding in the oropharynx and inability to visualize the glottis. After two failed direct laryngoscopic attempts to intubate, a size-2 air-Q ILA was inserted. A cuffed 5.0-mm inner diameter (ID) endotracheal tube (ETT) was blindly inserted through the lumen of the air-Q ILA into the trachea successfully. Case 2 was a 13-year-old boy who presented to the ED with a large nasopharyngeal laceration from a motor vehicle accident. After a rapid sequence intubation, direct laryngoscopy showed copious blood with no glottic visualization. A size 3 Laryngeal Mask Airway Classic™ (cLMA; LMA North America Inc., San Diego, CA) was inserted with a large airway leak, and blind ETT insertion via the cLMA was unsuccessful. Subsequently, a size-2.5 air-Q ILA was inserted and adequate ventilation was restored. A cuffed 6.0-mm ID ETT was blindly inserted through the air-Q ILA into the trachea successfully.

      Conclusion

      Two cases of failed laryngoscopy in pediatric patients with blood in the airway are described. In each case, insertion of an air-Q ILA was followed by successful blind tracheal intubation via the lumen of the air-Q ILA.

      Keywords

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