Use of two tracheal tubes and fibreoptic bronchoscope for intubation through a LMA Pro-Seal®in a difficult paediatric airway

Bronchoscope-Guided Airway Rescue via an I-gel™ for Haematoma-Induced Airway Obstruction Following Anterior Cervical Spine Surgery

Airway obstruction requiring emergency airway rescue is an uncommon yet potentially fatal complication following anterior cervical discectomy and fusion. This report describes rapid clinical deterioration after anterior cervical discectomy and fusion despite haematoma evacuation. After failing to secure the airway with awake bronchoscope-guided tracheal intubation and video-laryngoscopy, an I-gel™ supraglottic airway was inserted, and alveolar oxygenation was restored. Bronchoscope-guided intubation was easily achieved via the I-gel™ lumen. The practicality of this technique for airway rescue in the context of a high-stakes time-critical airway emergency is discussed.

Clinical analysis of bronchoscopic cryotherapy in 156 pediatric patients

BACKGROUND

The aim of this study was to investigate the efficacy and safety of bronchoscopic cryotherapy for pediatric poor ventilation.

METHODS

A total of 156 pediatric patients with airway stenosis and obstruction as well as pulmonary atelectasis received bronchoscopic cryotherapy. Treatment efficacy was evaluated on bronchoscopy Before cryotherapy and after the last cryotherapy treatment. Pulmonary atelectasis was assessed according to range of atelectasis on chest computed tomography (CT), and tracheobronchial stenosis according to pulmonary function, tidal volume analysis and dyspnea index.

RESULTS

The 154 patients with effective treatment had patent airway, smooth mucosa and resolved atelectasis. In the two patients with ineffective treatment, however, the airway was not smooth and the range of pulmonary atelectasis was reduced by <30%. Among the 156 patients, 136 had markedly effective treatment, with CT pulmonary atelectasis recovery >70%. The width of the main airway significantly increased approximately 50% and the tidal volume or capacity increased 100%. Effective treatment was identified in 18 patients (18/156), with CT pulmonary atelectasis area reduced 30-70%. Ineffective treatment was noted in two patients, with CT pulmonary atelectasis area reduced by <30%. No complications were noted in any patients during or after operation. No recurrence was noted on follow up of 2-24 months.

CONCLUSION

Bronchoscopic cryotherapy is effective and safe for dyspnea caused by airway obstruction, and wide application in clinic is recommended.