• J Emerg Med · Oct 2011

    Case Reports

    Successful tracheal intubation through an intubating laryngeal airway in pediatric patients with airway hemorrhage.

    • Narasimhan Jagannathan and David T Wong.
    • Department of Pediatric Anesthesiology, Children's Memorial Hospital, Northwestern University's Feinberg School of Medicine, Chicago, Illinois 60614, USA.
    • J Emerg Med. 2011 Oct 1; 41 (4): 369-73.

    BackgroundThis 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).ObjectivesTo describe the use of a new supraglottic rescue device in the management of the pediatric patient's difficult airway in the emergency setting.Case ReportCase 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.ConclusionTwo 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.Copyright © 2011 Elsevier Inc. All rights reserved.

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