Fiberoptic intubation via the laryngeal mask

Fiberoptic intubation via the laryngeal mask

Using the laryngeal mask for difficult tracheal intubation


Why do it
Fiberoptic intubation via the laryngeal mask represents a safe technique for endotracheal intubation in children with craniofacial malformations such as Treacher-Collins-Syndrome, Pierre-Robin-Sequence and generally all children with a compromised airway.

How to do it
Having secured the airway with a laryngeal mask place a swivel-connector with a valve between the laryngeal mask and the breathing system. This swivel-connector makes it possible to ventilate the child during the procedure. Remove the connector of the tube, thread the bare tube on the fiberscope and introduce the scope through the swivel-connector into the laryngeal mask until you have sight of the larynx. An assistant should stabilize the laryngeal mask to keep it in place. Then push the fiberscope carefully into the trachea and further into a main bronchus. After removal of the swivel-connector push the tube gently through the laryngeal mask into the trachea using the fiberscope as a railroad. Remove the fiberscope, check the tube's position in the trachea then set the connector on the tube and connect it with the breathing system.

How do it right. The fine points
Before you perform this procedure, check that all parts of your equipment such as laryngeal mask, tube and fiberscope will fit in terms of diameter and length. Also use a lubricant such as silicone spray to facilitate movement

Suggested reading
Walker RWM, Ellwood J. The Management of difficult intubation in children. Paediatr Anaesth. 2009 Jul;19 Suppl 1:77-87

Suggested equipment
Ambu Aura-i Laryngeal mask
Olympus fibrescopes

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