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
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.
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.
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.
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.