A New Algorithm for Pediatric Airway Management Using the Intubating Laryngeal Airway

Abstract

Objective: 1) Evaluate the use of the intubating laryngeal airway (ILA) in providing safe endotracheal intubations in pediatric patients with difficult airways. 2) Present a management algorithm using direct laryngoscopy, rigid bronchoscopy, and the ILA for evaluating and securing the airway in pediatric patients with difficult airways. Method: The medical records of patients in whom the ILA was used to secure the airway from January 2009 to January 2011 were reviewed. We documented the circumstances necessitating airway management, success of the ILA, airway evaluation findings, and medical conditions contributing to the difficult airway. Results: A total of 50 patients had an ILA placed for airway management. Nine out of 50 (18%) were performed emergently. The median age was 59.8 months (range, 0.3-244.1 months), and the median weight was 19.0 kg (range, 2.6-86 kg). Four cases (8%) were unanticipated difficult airways, and 46 out of 50 (92%) were anticipated difficult airways. Comorbid conditions included craniofacial syndromes (n = 36), cervical spine instability or immobility (n = 9), and airway hemorrhage (n = 3). A total of 48 out of 50 (96%) patients were intubated on the first attempt through the ILA. In 2 patients intubation required a second attempt. The overall success rate using the ILA to secure the airway was 100%. Conclusion: ILA is safe and effective in pediatric patients with a difficult airway as a conduit for tracheal intubation. Our proposed algorithm for difficult pediatric airway provides a safe means for anesthesiologists and otolaryngolgists to evaluate and secure the airway in these patients.