• Ichiro Kondo, Hidetsugu Kobayashi, Yoshihumi Suga, Akihiro Suzuki, Shuya Kiyama, and Shoichi Uezono.
• Department of Anesthesiology, Jikei University, Minato-ku, Tokyo, Japan.
• Paediatr Anaesth. 2017 Nov 1; 27 (11): 1115-1119.

BackgroundWith the increasing popularity of video laryngoscopy during intubation of pediatric patients with normal or difficult airways, fiberoptic-assisted tracheal intubation, traditionally considered the gold standard for difficult intubation, may become underused.AimWe aimed to assess the use of airway management techniques before and after introduction of video laryngoscopy in a cohort of school-aged children with microtia, who are at increased risk of difficult intubation.MethodsWe retrospectively reviewed intubation devices used for all pediatric patients with microtia who had undergone reconstructive ear surgery at a single institution during the period January 2008 to December 2012. In each case, we identified the original airway management technique and success rate, as well as success rate for subsequent rescue techniques. The use of fiberoptic-assisted tracheal intubation was compared before and after introduction of a pediatric blade for the Pentax-AWS video laryngoscope.ResultsThis study included 537 consecutive intubation procedures; 264 before and 273 after introduction of the pediatric airway scope. Elective use of fiberoptic-assisted tracheal intubation for anticipated difficult intubation was significantly less after introduction of the pediatric airway scope (before: 19 of 79, 24% vs after: 3 of 79, 4%; odds ratio 8.02; 95% confidence interval, 2.27 to 28.39; P = .0003), which achieved a 100% success rate when used as the primary technique in both routine and difficult airways. All 5 cases of failed direct laryngoscopy were rescued by the pediatric airway scope, thus eliminating emergency use of fiberscopy.ConclusionIntroduction of a pediatric video laryngoscope resulted in a substantial decrease in the use of fiberoptic-assisted tracheal intubation. This change in intubation method might not influence the success rate of intubation in experienced hands but could be relevant for novice users.© 2017 John Wiley & Sons Ltd.

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