Finger guided intubation in newborns and infants with difficult airways: a possible ignored technique.

摘要

Sir-We would like to congratulate Drs. Parameswari et al.(1) on successful airway management using nasal fiberoptic-guided orotracheal intubation in three children with Pierre Robin sequence. They have provided a modified intubation technique under fiberoptic observation. This technique is a useful alternative that can be used for orotracheal intubation in newborns and infants when the available fiberoptic bronchoscope (FOB) is too large to pass through the appropriate-sized endotracheal tube (ETT) and is lack of a working channel. However, a possible disadvantage is that a minimum of three persons are needed. One person would perform the fiberoptic laryngoscopy to expose the larynx, a second person would hold and manipulate the child's head, and the third person would manipulate the styletted ETT into the trachea through the glottis. Otherwise, overall process of their airway management seems somewhat complex and time-consuming. In newborns and infants, a particular concern for insertion of ETT and FOB via the bilateral nasal passages is the risk of nasal bleeding.