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Difficult intubation in children is rare and often predictable during anesthesia consultation. This allows to establish a strategy to provide fiberoptic guided tracheal intubation with spontaneous ventilation in function of age and children pathology. A good knowledge of physiologic and anatomic children particularities, of fiberoptic technique and the respect for some principles lead to ensure the security of this procedure. First principle is to use only one anesthetic inhaled or intravenous agent in order to limit an important decrease of ventilation. The anesthetic technique recommended for pediatric fiberoptic guided intubation is inhaled anesthesia with sevoflurane. But it is possible to use an intravenous agent, like propofol, with a continuous infusion (bolus of 0.1 to 0.3 mg/kg then 0.1-0.3mg/kg per hour for maintenance) or with target controlled infusion (Schnider model, initial concentration 2.5 μg/mL, then increase by 0.5 μg/mL steps) particularly in children older than 5 years with an anesthetic depth control. Whatever the agent, the dose must to be titrated to maintain spontaneous ventilation. Second principle is to combine an airway local anesthesia with general anesthesia to limit airway reactivity. First, a nose topical anesthesia is administered with lidocaine plus naphazoline in children older than 2 years. Then, a laryngeal topical anesthesia is realized with lidocaine 1% (1-2 mL, 2mg/kg) through operating channel of fiberoptic bronchoscope. Finally, third principle is to ensure patient oxygenation with several techniques like use of endoscopic facial mask or nasopharyngeal tube. The use of laryngeal mask is a rescue technique in case of spontaneous ventilation lost. In conclusion, each institution has to establish an algorithm with his own knowledge, constantly feasible and regularly taught., (Copyright © 2013. Published by Elsevier SAS.)

Objective: The primary purpose of this experimental study was to compare intubation times for direct laryngoscopy with a Miller blade and for 3 VL: GlideScope® videolaryngoscope, Airtraq®, and McGrath®., Methods: Seventy-seven operators, with various experience of pediatric tracheal intubation (from none to expert), performed 10 attempts of orotracheal intubation with each device on an infant manikin. The main outcome was intubation time and secondary outcome was failure rate., Results: There was a significant decrease in intubation time from the first to the 10th intubation attempt with all devices (P<0.05). This decrease was no more significant following the third attempt with VL and following the fifth attempt with DL. At the time of the 10th attempt, intubation time was significantly shorter with Airtraq® as compared with all the other devices (P<0.05), but the differences were tight. Failure was significantly more frequent with DL., Conclusion: In this infant manikin model, the learning curve of the different VL was 3 attempts and the Airtraq® VL appears the airway device enabling the quickest orotracheal intubation. These experimental results need to be confirmed by clinical studies in infants and children., (Copyright © 2013 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier SAS. All rights reserved.)