CR#24 Airtraq in a 5-month-old infant with a difficult airway because of Robin Sequence

Paediatric Anaesthesia 19,695-715 
Vlatten , Pediatric Anesthesia, IWK Health Centre, Halifax, Canada

A 5-month-old, 4.8-kg infant, born at 33-week gestation (corrected age 3 months) was presented for management of severe gastroesophageal reflux. The infant was born with facial dysmorphism including severe micrognathia, retrognathia, and cleft palate (Robin Sequence).
Previously, at 4 months age, the child had undergone a magnetic resonance image (MRI) scan under general anesthesia. Laryngoscopy at that time revealed a difficult airway with a Cormack–Lehane grade 3b view of the larynx. Intubation attempts were discontinued, and the MRI was performed under spontaneously breathing inhalational anesthesia using a laryngeal mask.
Direct laryngoscopy using a Miller 1 blade, augmented by external laryngeal manipulation resulted in a Cormack–Lehane grade 3b view (tip of retroverted epiglottis only) and percent of glotttic opening (POGO) score seen was 0%. An Airtraq size 0 (infant) preloaded with a 3.0-mm ID microcuff endotracheal tube was inserted into the oropharynx. The Airtraq provided a full view of the entire glottic opening (Cormack–Lehane grade 1, POGO score 100%). The ett was advanced along the Airtraq guide channel through the vocal cords on first attempt.

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