Total airway management by using a guide. Difficult intubation in the newborn and young infants
Watanabe, S.; Yamashita, M.; Satoh, S.; Watanabe, T.; Watanabe, T.; Mohri, K.; Naito, H.
Masui. Japanese Journal of Anesthesiology 29(8): 816-820
1980
ISSN/ISBN: 0021-4892 PMID: 7206204 Document Number: 155681
In human newborns and infants with airway disease the use of a guide for endotracheal intubation, rather than resorting to tracheostomy, was investigated. Retrograde translaryngeal guide was used for endotracheal intubation. This was never used in newborns and young infants. After a guide is brought up into the mouth or nose retrogradely through the cricothyroid membrane, by direct puncture or through an intravenous catheter, an endotracheal tube is passed over the guide into the larynx. This technique was used in a 16 mo. old boy with a huge neck mass causing airway obstruction. In another case a catheter guide was introduced as far down as possible into the lung through the endotracheal tube. The proximal end of the catheter stays out of the respiratory circuit like the endotidal sampling port. Should the endotracheal tube come out accidently, O2 can be flushed through it while attempting to put the tube back in place using the catheter as a guide. This was used on a 22 day old baby with a laryngeal cyst removed surgically. Postoperatively, the endotracheal tube is pulled out leaving the guide in place for emergency intubation. An uneventful post-extubation period was attained with this technique in a baby with Pierre-Robin syndrome, for which the tip of the tongue and the lower lip were sutured together to make his airway patent. A catheter used in the 3 different modes can be an alternative to tracheostomy.