Teaching the use of fiberoptic intubation for children older than two years of age
In 144 anesthetized children aged 2-9 yr, the safety and feasibility of orotracheal fiberoptic intubation, with and without an airway endoscopy mask, were assessed and compared with laryngoscopic intubation. Eight anesthesia residents with experience in adult fiberoptic intubation, but who were beginners in pediatric anesthesia, participated in this study. In a randomized fashion, each resident intubated 18 children (6 in each group). The time (mean ± SD) to achieve successful intubation was different for laryngoscopic and fiberoptic intubation (34 ± 17 s and 80 ± 39 s, respectively; P &lt; 0.001). The use of the airway endoscopy mask further prolonged fiberoptic intubation (167 ± 121 s, P &lt; 0.001). Spo2 values remained &gt;95% in all patients during conventional laryngoscopy and fiberoptic laryngoscopy with a mask, whereas Spo2 decreased below 95% in 2 of the 48 patients during fiberoptic intubation without a mask. Both patients promptly recovered during ventilation via a face mask. We conclude that teaching the use of fiberoptic intubation in healthy, anesthetized children aged 2-9 yr is safe and feasible. Implications: Fiberoptic intubation is a valuable technique of airway management. We studied the feasibility and safety of a training program that could be used for children more than 2 yr old. This study demonstrates that fiberoptic intubation can be effectively practiced in pediatric patients without increased risk of side effects.