How to Perform Straight Intubation with an Armoured Tube in Pediatric Patients with Normal Airway Anatomy

다국어 초록 (Multilingual Abstract)

Background: No study to date has confirmed the possibility of using the sniffing position for performing straight intubation. The objective of this study was to evaluate the head position for intubation with the armoured tube during direct laryngoscopy. Methods: One hundred pediatric patients (males: 61, females: 39, aged 1-15 years) were included in this study. Initially, we tried to intubate the armored endotracheal tube in a straight fashion in every subject by placing the patient in the sniffing position and we recorded whether the procedure was successful. We measured the distance (D: occiput to flat table) and the angle (α: between the occiput-shoulder line and flat table line) at the moment of successful intubation and we also calculated the body mass index (BMI). Results: The armored tube could be intubated in a straight fashion in all patients (82/82, 100%) for a head elevation at the height of 8.19 ± 2.03 cm (4.4-14.2 cm) from the flat table, but we were only successful in 18/100 (18%) patients placed in the sniffing position (P ＜ 0.0001). There were statistically significant differences between head elevation and the sniffing position for the D and the α (P ＜ 0.0001). Conclusions: Elevating the head approximately 8 cm from operating table and simultaneous mandibular advancement via the laryngoscope during direct laryngoscopy makes it possible to perform straight intubation with the armored tube during direct laryngoscopy in pediatric patients with normal airway anatomy. We recommend that our head elevation technique, which goes beyond the sniffing position, might be a good practice for performing pediatric anesthesia with the armoured tube. (Korean J Anesthesiol 2006; 51: S 1~5)