Pediatric flexible fiberoptic bronchoscopy through the laryngeal mask airway.

ABSTRACT

OBJECTIVE: To determine the usefulness and safety of the laryngeal mask airway (LMA) as an adjunct to pediatric flexible fiberoptic bronchoscopy (FOB). DESIGN: A case-series retrospective study. SETTING: Pediatric otolaryngology tertiary referral center, outpatient and inpatient operating suites. PATIENTS Retrospective review of charts of children who had FOB performed with the use of LMA by the pediatric otolaryngology service. The patients were ages 3 months to 18 years with respiratory symptoms requiring FOB for diagnosis. INTERVENTIONS: Use of LMA to support airway during FOB with spontaneous ventilation with the patients under general anesthesia. MAIN OUTCOME MEASURES: Ability to perform airway evaluation with FOB and LMA; number and type of complications. RESULTS: Seventeen patients, ages 3 months to 18 years (median age, 39 months) underwent FOB with use of LMA. In 2 patients use of LMA failed-1 from airway obstruction with LMA in place, which required intubation, and another who could not have LMA appropriately placed. Fifteen patients underwent uncomplicated FOB through the LMA. None of these 15 patients required unplanned endotracheal intubation. Two patients with mandibular hypoplasia required LMA use for airway evaluation when the glottis could not be visualized at direct laryngoscopy. CONCLUSIONS: The LMA is a safe and effective adjunct to pediatric FOB. Laryngeal mask airway use for FOB allows evaluation of the airway during spontaneous ventilation without an endotracheal tube or a face mask. Larger fiberoptic scopes can be used through the LMA compared with pediatric FOB performed through the nose or through an endotracheal tube.