Successful tracheal intubation using fiberoptic bronchoscope via an I-gel™ supraglottic airway in a pediatric patient with Goldenhar syndrome -A case report-

Abstract

The I-gel™ is a single-use supraglottic airway device introduced in 2007 which features a non-inflatable cuff and allows passage of a tracheal tube owing to its large diameter and short length of the airway tube. In this case, the authors experienced a difficult airway management on a 4-year-old boy with underlying Goldenhar syndrome who underwent a tonsillectomy. Intubation using a laryngoscope was unsuccessful at the first attempt. In the following attempt, we used the I-gel™ supraglottic airway for ventilation and were able to achieve successful intubation with a cuffed tube by using fiberoptic bronchoscope through the I-gel™ supraglottic airway. The authors suggest that I-gel™ is a useful device for ventilation and it has many advantages for tracheal intubation in pediatric patients with difficult airway.

Keywords: Airway management; Fiberoptic bronchoscope; Goldenhar syndrome; Laryngeal mask airway; Pediatric.

Fig. 1

4-year-old male with Goldenhar syndrome. (A) Facial asymmetry of the right side. (B) conjunctival dermoid on the right eye. (C) Malformation of the right ear.

Fig. 2

Setting of ID 4.5 mm cuffed tracheal tube over a fiberoptic bronchoscope through an size 2 I-gel™.

Fig. 3

The proximal end of the tracheal tube is held by a tube exchanger larger than inner diameter of the tracheal tube to prevent accidental dislocation of the tracheal tube while I-gel™ is withdrawn.

Fig. 4

Supraglottic airways used for pediatric airway management. (A) Size 2 I-gel™, (B) Size 2 LMA Classic™, (C) Size 1.5 LMA Unique™. While (B) LMA Classic™, and (C) LMA Unique™, both have aperture bars, (A) I-gel™, lacks an aperture bar but instead has a wider stem.