Date: 28 Sep 2010

A simple method to deliver pharyngeal anesthesia in syndromic infants prior to awake insertion of the intubating laryngeal airway

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To the Editor,

Infants with a craniofacial abnormality who are potentially difficult to mask ventilate may benefit from awake placement of a supraglottic device to aid in tracheal intubation.1 Moreover, in some syndromic infants, severe upper airway obstruction may be present at birth, which often requires a mandibular advancement procedure or a tracheostomy.2 As these procedures require general anesthesia, clinicians may be hesitant to proceed with induction of anesthesia until upper airway obstruction is relieved. Options with the potential to alleviate airway obstruction prior to induction of anesthesia include: a change in position of the patient from supine to lateral or prone, placement of a naso-pharyngeal airway,3 or awake insertion of a supraglottic airway device.1 In this clinical scenario, the primary advantage of a supraglottic device is to relieve upper airway obstruction while providing a reliable conduit for tracheal intubation. Awake placement of the laryngeal mask airwa