Abstract
Purpose
There are a number of syndromes with proven or suspected instability of the cervical spine especially in pediatric patients. It is a challenge for the anesthesiologist to intubate these patients with as little movement of the cervical spine as possible. A new device to facilitate this task is the angulated video-intubation laryngoscope (AVIL).
Clinical features
The AVIL is a curved endoscopic intubation laryngoscope with angulated distal tip. The video-view from the distal blade tip improves glottic visualization during difficult direct laryngoscopy. We report three sisters with Morquio syndrome scheduled for otorhinolaryngology surgery the same day. Two of them had radiologically suspected cervical spine instability. Tracheal intubation was planned with careful direct laryngoscopy under manual in-line stabilization of the neck and head by an assistant. Direct visualization of the larynx using a Miller blade No. 2 was impaired in two of the three children in whom the cervical spine was immobilized. They were both successfully intubated under endoscopie control using the AVIL.
Conclusion
The AVIL may become a helpful device to aid endotracheal intubation in patients when cervical spine immobilization impairs direct laryngoscopy.
Résumé
Objectif
De nombreux syndromes comportent une instabilité reconnue ou présumée de la colonne cervicale, surtout chez les enfants. C’est un défi pour l’anesthésiologiste de procéder à l’intubation en bougeant la colonne cervicale le moins possible. Un nouveau dispositif, le laryngoscope angulaire pour intubation vidéo (LAN), peut faciliter cette manoeuvre.
Eléments cliniques
Le LAIV est un laryngoscope d’intubation endoscopique courbé dont la pointe distale est anglée. L’image vidéo provenant de cette pointe de la lame permet de mieux visualiser la glotte pendant la laryngoscopie directe. Nous présentons le cas de trois soeurs atteintes de la maladie de Morquio devant subir une intervention oto-rhino-laryngologique le même jour. L’examen radiologique de deux patientes laissait présager une instabilité de la colonne cervicale. L’intubation endotrachéale, planifiée avec une laryngoscopie directe prudente, a été réalisée sous stabilisation manuelle synchronisée du cou et de la tête par un assistant. La visualisation laryngoscopique directe, réalisée avec une lame Miller no 2, a été difficile chez deux des enfants dont la colonne cervicale avait été immobilisée. L’intubation des deux enfants a été réussie sous contrôle endoscopique en utilisant le LAIV.
Conclusion
Le LAIV peut devenir un instrument utile à l’intubation endotrachéale chez des patients dont l’immobilisation de la colonne cervicale affecte la laryngoscopie directe.
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Dullenkopf, A., Holzmann, D., Feurer, R. et al. Tracheal intubation in children with Morquio syndrome using the angulated video-intubation laryngoscope. Can J Anesth 49, 198–202 (2002). https://doi.org/10.1007/BF03020496
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DOI: https://doi.org/10.1007/BF03020496