A comparison of Bonfils intubation fiberscopy and fiberoptic bronchoscopy in difficult airways assisted with direct laryngoscopy / 대한마취과학회지

BACKGROUND: To evaluate the usefulness of Bonfils intubation fiberscope assisted by direct laryngoscopy (BIF-DL) and flexible fiberoptic bronchoscope assisted by direct laryngoscopy (FOB-DL) using video recording in cases of unanticipated difficult intubation with respect to the time required to visualize the vocal cords and place the endotracheal tube. We compared two fiberscopes in patients with authentic difficult airways. METHODS: In this randomized, controlled clinical trial, 40 patients (grade 3 according to grades of difficulty in laryngoscopy), scheduled for surgery under general anesthesia were randomly allocated to BIF-DL group or FOB-DL group. Number of attempts, time required for visualization of the vocal cord (T1) and placement of the endotracheal tube (T2) from insertion of instrument during the last successful attempt, and duration of scope manipulation during all attempts (T(total)) were recorded. If intubation failed with one method, the other method was tried; these cases were then excluded. The incidence of sore throat and hoarseness was assessed. RESULTS: T1, T2, and T(total) were significantly shorter in BIF-DL group (T1: 21.9 +/- 8.2 sec vs. 80.4 +/- 29.9 sec, P < 0.001, Ttotal: 77.9 +/- 41.2 sec vs. 145.5 +/- 83.9 sec, P = 0.003). In two cases, it was impossible to intubate with BIF-DL, but the procedure was subsequently successful using fibreoptic bronchoscope. CONCLUSIONS: Intubation of difficult airways can be performed more rapidly with BIF-DL, but sometimes it may not be possible to intubate with the scope.

Anesthetic management for child with idiopathic ketotic hypoglycemia: A case report

Idiopathic ketotic hypoglycemia (IKH) is the common cause of clinically significant non-diabetic hypoglycemia among children. The cause of IKH is decrease in endogenous glucose production after a prolonged fasting. We report the experience of perioperative management for a six-year-old female child undergoing strabismus surgery with a history of IKH. This patient experienced two episodes of severe hypoglycemia and loss of consciousness caused by prolonged fasting at the age of 31 and 41 months. For elective general anesthesia, children should be restricted from fluid and foods to prevent pulmonary aspiration. Because of higher metabolic rate and larger body surface area-to-weight ratio than adult, pediatric patient are more prone to hypovolemia and hypoglycemia during preoperative fasting period. When the preoperative fasting is inevitable in the child with IKH, anesthesiologist should start the parenteral infusion with dextrose-containing fluid and periodically check blood glucose level during perioperative period.