Newly Published
Perioperative Medicine  |   June 2017
Videolaryngoscopy versus Fiber-optic Intubation through a Supraglottic Airway in Children with a Difficult Airway: An Analysis from the Multicenter Pediatric Difficult Intubation Registry
Author Notes
  • From the Department of Pediatric Anesthesiology, Ann and Robert H. Lurie Children’s Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, Illinois (N.E.B., N.J.); Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania (A.N., J.E.F., K.N.P.); Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida (H.D.A.); Department of Anesthesiology and Pain Medicine, Nationwide Children’s Hospital, Ohio State University, Columbus, Ohio (V.T.R.); Department of Anesthesiology and Pain Management, University of Texas Southwestern and Children’s Health System of Texas, Dallas, Texas (P.N.O.); and Department of Anesthesiology, Perioperative and Pain Medicine, Children’s Hospital of Boston, Harvard School of Medicine, Boston, Massachusetts (P.G.K.).
  • Department of Anesthesiology and Pain Medicine, Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, Washington
  • Department of Anesthesiology and Pain Medicine, Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, Washington
  • Department of Anesthesiology and Pain Medicine, Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, Washington
  • Department of Anesthesiology and Pain Medicine, Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, Washington
  • Department of Anesthesiology, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas
  • Department of Anesthesiology, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas
  • Department of Anesthesiology, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas
  • Department of Anesthesiology and Pain Management, University of Texas Southwestern and Children’s Health System of Texas, Dallas, Texas
  • Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
  • Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
  • Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
  • Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
  • Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee
  • Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee
  • Department of Pediatric Anesthesiology, University of Michigan Health Center, Ann Arbor, Michigan
  • Department of Anesthesiology, University of Texas Medical School at Houston, Houston, Texas
  • Department of Anesthesiology, University of Texas Medical School at Houston, Houston, Texas
  • Department of Anesthesiology, University of Texas Medical School at Houston, Houston, Texas
  • Department of Anesthesiology, Children’s Hospital of Colorado, Aurora, Colorado
  • Department of Anesthesiology, Children’s Hospital of Colorado, Aurora, Colorado
  • Department of Anesthesiology, Children’s Hospital of Colorado, Aurora, Colorado
  • Department of Anesthesiology, University of Mississippi Medical Center, Jackson, Mississippi
  • Department of Anesthesiology, Duke University, Durham, North Carolina
  • Department of Anesthesiology and Pain Management, Children’s Hospital of Cleveland Clinic, Cleveland, Ohio
  • Department of Anesthesia, Critical Care and Pain, Massachusetts General Hospital, Boston, Massachusetts
  • Department of Anesthesiology and Pain Medicine, Nationwide Children’s Hospital, Ohio State University, Columbus, Ohio
  • Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
  • Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
  • Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
  • Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
  • Department of Anesthesiology and Pain Management, University of Western Australia, Crawley, Australia
  • Department of Anesthesiology and Pain Management, University of Western Australia, Crawley, Australia
  • Department of Anesthesiology, University of New Mexico, Albuquerque, New Mexico
  • Department of Anesthesiology, Weill Cornell Medical College, New York, New York
  • Dep.artment of Anesthesiology, University of Minnesota, Minneapolis, Minnesota
  • Dep.artment of Anesthesiology, University of Minnesota, Minneapolis, Minnesota
  • Department of Anesthesiology, National Institute of Pediatrics, Mexico City, Mexico
  • Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical Center, Stanford, California
  • Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
  • Department of Anesthesiology, Perioperative and Pain Medicine, Children’s Hospital of Boston, Harvard School of Medicine, Boston, Massachusetts
  • Department of Anesthesiology, Perioperative and Pain Medicine, Children’s Hospital of Boston, Harvard School of Medicine, Boston, Massachusetts
  • Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).
    Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).×
  • Submitted for publication September 16, 2016. Accepted for publication May 23, 2017.
    Submitted for publication September 16, 2016. Accepted for publication May 23, 2017.×
  • Research Support: Supported by internal funding from the Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
    Research Support: Supported by internal funding from the Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.×
  • *Members of PeDI Collaborative Investigators are listed in the appendix.
    Members of PeDI Collaborative Investigators are listed in the appendix.×
  • Competing Interests: Dr. Nishisaki has been supported by the Agency for Healthcare Research and Quality under grant Nos. AHRQ R03HS021583, AHRQ R18 HS022464-01, and AHRQ R18HS024511-01, and unrestricted grant support from Nihon Kohden, Inc. (Tokyo, Japan). These are unrelated to this study. Dr. Raman has been supported by the Society of Anesthesia and Sleep Medicine (Milwaukee, Wisconsin) for obstructive sleep apnea research. This is unrelated to this study. Dr. Olomu and Dr. Jagannathan are consultants for Teleflex Medical, Inc. (Kenosha, Wisconsin), and receive honoraria for travel to meetings where future airway device design is discussed. This is unrelated to this study. Mr. Adams is the recipient of a FAER Medical Student Anesthesia Research Fellowship Summer Program grant, which supported work related to this project.
    Competing Interests: Dr. Nishisaki has been supported by the Agency for Healthcare Research and Quality under grant Nos. AHRQ R03HS021583, AHRQ R18 HS022464-01, and AHRQ R18HS024511-01, and unrestricted grant support from Nihon Kohden, Inc. (Tokyo, Japan). These are unrelated to this study. Dr. Raman has been supported by the Society of Anesthesia and Sleep Medicine (Milwaukee, Wisconsin) for obstructive sleep apnea research. This is unrelated to this study. Dr. Olomu and Dr. Jagannathan are consultants for Teleflex Medical, Inc. (Kenosha, Wisconsin), and receive honoraria for travel to meetings where future airway device design is discussed. This is unrelated to this study. Mr. Adams is the recipient of a FAER Medical Student Anesthesia Research Fellowship Summer Program grant, which supported work related to this project.×
  • Correspondence: Address correspondence to Dr. Jagannathan: Ann and Robert H. Lurie Children’s Hospital of Chicago, 225 E. Chicago Avenue, Chicago, Illinois 60611. simjag2000@gmail.com. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Airway Management / Pediatric Anesthesia / Technology / Equipment / Monitoring
Perioperative Medicine   |   June 2017
Videolaryngoscopy versus Fiber-optic Intubation through a Supraglottic Airway in Children with a Difficult Airway: An Analysis from the Multicenter Pediatric Difficult Intubation Registry
Anesthesiology Newly Published on June 29, 2017. doi:10.1097/ALN.0000000000001758
Anesthesiology Newly Published on June 29, 2017. doi:10.1097/ALN.0000000000001758
Abstract

Background: The success rates and related complications of various techniques for intubation in children with difficult airways remain unknown. The primary aim of this study is to compare the success rates of fiber-optic intubation via supraglottic airway to videolaryngoscopy in children with difficult airways. Our secondary aim is to compare the complication rates of these techniques.

Methods: Observational data were collected from 14 sites after management of difficult pediatric airways. Patient age, intubation technique, success per attempt, use of continuous ventilation, and complications were recorded for each case. First attempt success and complications were compared in subjects managed with fiber-optic intubation via supraglottic airway and videolaryngoscopy.

Results: Fiber-optic intubation via supraglottic airway and videolaryngoscopy had similar first attempt success rates (67 of 114, 59% vs. 404 of 786, 51%; odds ratio 1.35; 95% CI, 0.91 to 2.00; P = 0.16). In subjects less than 1 yr old, fiber-optic intubation via supraglottic airway was more successful on the first attempt than videolaryngoscopy (19 of 35, 54% vs. 79 of 220, 36%; odds ratio, 2.12; 95% CI, 1.04 to 4.31; P = 0.042). Complication rates were similar in the two groups (20 vs. 13%; P = 0.096). The incidence of hypoxemia was lower when continuous ventilation through the supraglottic airway was used throughout the fiber-optic intubation attempt.

Conclusions: In this nonrandomized study, first attempt success rates were similar for fiber-optic intubation via supraglottic airway and videolaryngoscopy. Fiber-optic intubation via supraglottic airway is associated with higher first attempt success than videolaryngoscopy in infants with difficult airways. Continuous ventilation through the supraglottic airway during fiber-optic intubation attempts may lower the incidence of hypoxemia.