Fiberoptic endotracheal intubation after topicalization with in-circuit nebulized lidocaine in a child with a difficult airway.

Abstract

This case report describes the successful fiberoptic intubation of an uncooperative child with a difficult airway due to gross burn scarring in the facial and neck region by administering 4% end-tidal sevoflurane and simultaneously delivering 4% nebulized lidocaine via a small-volume nebulizer that was connected to the inspiratory limb of the circle system via a T-piece adapter. This case suggests that simultaneously administering a volatile anesthetic with nebulized lidocaine might be an alternative way to deliver lidocaine and might provide better topical anesthesia for uncooperative patients. An in-circuit nebulization system to deliver topical lidocaine may facilitate fiberoptic-assisted intubation in anesthetized, spontaneously breathing children with compromised airways.