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A left paraglossal approach for oral intubation in children scheduled for bilateral orofacial cleft reconstruction surgery--a prospective observational study.
Paediatr Anaesth. 2009 Feb; 19(2):159-63.PA

Abstract

BACKGROUND

Children with orofacial cleft defects are expected to have difficult airways. Conventional midline laryngoscopic approach of oral intubation can lead to iatrogenic tissue trauma. In this study, we evaluated the feasibility of left paraglossal laryngoscopy as a primary technique for airway management in these children.

METHODS

After institutional ethical committee approval and informed consent, we enrolled 21 children with uncorrected bilateral lip and palate deformities (BL CL/P). Anesthesia was induced with halothane (0.5-4%) in 100% oxygen. After obtaining intravenous access, fentanyl 1.5 microg x kg(-1) and atracurium 0.5 mg x kg(-1) were administered. Endotracheal intubation was performed with Miller's straight blade laryngoscope, introduced using left paraglossal approach. Difficulty of intubation was scored according to modified Intubation Difficulty Scale.

RESULTS

Data consists of 21 children (15 males and six females), mean age 1.31 +/- 1.18 years and weight 9.27 +/- 2.57 kg. Laryngoscopic view obtained was CL II (7[33.3%]) and CL I (14[66.6%]) respectively (Figure 1). All the children could be easily intubated using left paraglossal approach, only 2/3 of them needed optimal external laryngeal manipulation to help achieving it. Though intubation could be done in the first attempt in 19 children, two infants (9 1/2 and 11 months) required one size smaller endotracheal tube and were intubated in the second attempt using left paraglossal approach. Perioperative course was uneventful in all the children.

CONCLUSION

Keeping in mind midline tissue support loss in cleft deformities, we propose routine use of left paraglossal laryngoscopic approach for intubating children with uncorrected BL CL/P anomalies.

Authors+Show Affiliations

Department of Anesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India. indumohini@gmail.comNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Evaluation Study
Journal Article

Language

eng

PubMed ID

19207900

Citation

Sen, Indu, et al. "A Left Paraglossal Approach for Oral Intubation in Children Scheduled for Bilateral Orofacial Cleft Reconstruction Surgery--a Prospective Observational Study." Paediatric Anaesthesia, vol. 19, no. 2, 2009, pp. 159-63.
Sen I, Kumar S, Bhardwaj N, et al. A left paraglossal approach for oral intubation in children scheduled for bilateral orofacial cleft reconstruction surgery--a prospective observational study. Paediatr Anaesth. 2009;19(2):159-63.
Sen, I., Kumar, S., Bhardwaj, N., & Wig, J. (2009). A left paraglossal approach for oral intubation in children scheduled for bilateral orofacial cleft reconstruction surgery--a prospective observational study. Paediatric Anaesthesia, 19(2), 159-63. https://doi.org/10.1111/j.1460-9592.2008.02870.x
Sen I, et al. A Left Paraglossal Approach for Oral Intubation in Children Scheduled for Bilateral Orofacial Cleft Reconstruction Surgery--a Prospective Observational Study. Paediatr Anaesth. 2009;19(2):159-63. PubMed PMID: 19207900.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A left paraglossal approach for oral intubation in children scheduled for bilateral orofacial cleft reconstruction surgery--a prospective observational study. AU - Sen,Indu, AU - Kumar,Sushil, AU - Bhardwaj,Neerja, AU - Wig,Jyotsna, PY - 2009/2/12/entrez PY - 2009/2/12/pubmed PY - 2009/6/12/medline SP - 159 EP - 63 JF - Paediatric anaesthesia JO - Paediatr Anaesth VL - 19 IS - 2 N2 - BACKGROUND: Children with orofacial cleft defects are expected to have difficult airways. Conventional midline laryngoscopic approach of oral intubation can lead to iatrogenic tissue trauma. In this study, we evaluated the feasibility of left paraglossal laryngoscopy as a primary technique for airway management in these children. METHODS: After institutional ethical committee approval and informed consent, we enrolled 21 children with uncorrected bilateral lip and palate deformities (BL CL/P). Anesthesia was induced with halothane (0.5-4%) in 100% oxygen. After obtaining intravenous access, fentanyl 1.5 microg x kg(-1) and atracurium 0.5 mg x kg(-1) were administered. Endotracheal intubation was performed with Miller's straight blade laryngoscope, introduced using left paraglossal approach. Difficulty of intubation was scored according to modified Intubation Difficulty Scale. RESULTS: Data consists of 21 children (15 males and six females), mean age 1.31 +/- 1.18 years and weight 9.27 +/- 2.57 kg. Laryngoscopic view obtained was CL II (7[33.3%]) and CL I (14[66.6%]) respectively (Figure 1). All the children could be easily intubated using left paraglossal approach, only 2/3 of them needed optimal external laryngeal manipulation to help achieving it. Though intubation could be done in the first attempt in 19 children, two infants (9 1/2 and 11 months) required one size smaller endotracheal tube and were intubated in the second attempt using left paraglossal approach. Perioperative course was uneventful in all the children. CONCLUSION: Keeping in mind midline tissue support loss in cleft deformities, we propose routine use of left paraglossal laryngoscopic approach for intubating children with uncorrected BL CL/P anomalies. SN - 1460-9592 UR - https://www.unboundmedicine.com/medline/citation/19207900/A_left_paraglossal_approach_for_oral_intubation_in_children_scheduled_for_bilateral_orofacial_cleft_reconstruction_surgery__a_prospective_observational_study_ L2 - https://doi.org/10.1111/j.1460-9592.2008.02870.x DB - PRIME DP - Unbound Medicine ER -