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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Article info
Publication history
Published online: August 30, 2010
Accepted:
May 2,
2010
Received in revised form:
February 2,
2010
Received:
November 8,
2009
Identification
Copyright
© 2011 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
