Videolaryngoscopy for teaching and supervising rigid bronchoscopy in paediatric patients

Impiego della videolaringoscopia per l'insegnamento e la supervisione della broncoscopia rigida in pazienti pediatrici Dear Editor, Rigid bronchoscopy is frequently used by otolaryngolo-gists to evaluate the trachea and bronchi in paediatric patients. Bronchoscopes are introduced through vocal cords under direct vision laryngoscopy 1. Poor glottic exposure leads to multiple intubation attempts with the rigid bronchoscope and, subsequently, may be associated with oxygen desaturation or airway and dental injuries 2. Teaching and supervising otolaryngology residents to in-tubate the trachea with a rigid bronchoscope under direct vision laryngoscopy is difficult in paediatric patients. Low lung vital capacity and high oxygen consumption in small children also limits residents' training time. Furthermore, as airway spaces are narrow, instructors cannot see what the trainees are visualising, cannot recognise the trainee's problems and have to perform tracheal intubation themselves. This may delay the learning curve of rigid bron-choscopy in otolaryngology residency programmes. The C-MAC videolaryngoscope (Karl Storz, Tuttlingen, Germany) is a relatively new device using modified Macin-tosh or Miller blades. It provides the possibility of obtaining both direct view of the larynx and a camera view displayed on a monitor screen 2 3. This device not only improves visu-alisation of the vocal cords, but also allows an operator assistant to follow the intubation process on the monitor, and to help in optimising the glottic view by external laryngeal manipulations 4. The C-MAC videolaryngoscope has already been used as a teaching tool for tracheal intubation in children 3 5 6. In this report, we describe the use of a C-MAC videolaryngoscope as a device for training and supervising otolaryngology residents to intubate the trachea with a rigid bronchoscope in paediatric patients. Twenty consecutive patients aged between 3 months and 2 years and scheduled for rigid bronchoscopy under general anaesthesia were included in this case series. Institutional approval and parental informed consent was obtained. In the operating theatre, all patients had standard monitoring including three-lead electrocardiography, pulse oximetry, non-invasive blood pressure measurement and end-tidal capnography. Following general anaesthesia through mask induction with sevoflurane, an intravenous access was secured and 4% lidocaine was topically applied with an at-omizer to anaesthetise the vocal cords. A second year oto-laryngology resident placed the patient's head in moderate extension and exposed the larynx using a C-MAC videola-ryngoscope with an appropriate-sized straight Miller blade. The resident introduced the tip of the rigid bronchoscope into the oral cavity, and gently directed it towards the la-ryngeal …