• Narasimhan Jagannathan, Melanie F Kho, Ryan J Kozlowski, Lisa E Sohn, Aisha Siddiqui, and David T Wong.
• Department of Pediatric Anesthesiology, Children's Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL 60614, USA. simjag2000@yahoo.com
• Paediatr Anaesth. 2011 Apr 1;21(4):422-7.

ObjectivesTo assess the efficacy of the ILA as a conduit for tracheal intubation in pediatric patients with a difficult airway.AimThe primary goals of this retrospective audit were to assess the clinical performance of the ILA in pediatric patients with a difficult airway, expand on our initial favorable experience with this device, and collect pilot data for future prospective and comparison studies.MethodsThe charts of patients with a difficult airway in whom the ILA was used during a period of 1 year in a freestanding pediatric institution were reviewed following a practice change in the authors' institution favoring the ILA over the laryngeal mask airway as a conduit for tracheal intubation.ResultsThirty-four pediatric patients had an ILA placed during the course of their airway management. Eight of the 34 patients in this cohort required emergent airway management. The median age was 47.1 (0.3-202.2) months and the median weight was 16.3 (3.9-86.0) kilograms. Three of the cases were unanticipated difficult airways and the remaining were anticipated difficult airways as a result of craniofacial syndromes (n = 21), cervical spine instability or immobility (n = 7), or airway hemorrhage (n = 3). Thirty-three of the 34 patients (97%) were intubated on the first attempt through the ILA, with the aid of a fiberoptic bronchoscope (n = 25), a Shikani Optical Stylet (n = 7), or blindly (n = 2). In one patient, blind tracheal intubation required a second attempt for successful intubation, making the overall success rate 100%. Oxygen desaturation was noted in 6 of the 34 cases.ConclusionsIn a series of pediatric patients with difficult airways, the ILA was successfully used as a conduit for tracheal intubation in all patients. Visualization techniques may offer a greater degree of success in intubations through the ILA due to the potential for epiglottic down-folding in children.© 2010 Blackwell Publishing Ltd.

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