Anesthesia and airway management
oropharyngeal or laryngeal trauma, glottis, desaturation, hoarseness
COMPLICATIONS
The children were preoxygenated with 100% ONext, a fibreoptic evaluation of LMA placement was performed with a fibreoptic intubation scope, The glottis viewwas assessed and graded as follows [The classification by SaCoVLM. Grade 1: the lateral part of the right aryepiglottic fold and part of the laryngeal inlet and the ventilation was good. Grade 2: visualization of the bilateral aryepiglottic fold and part of the laryngeal inlet and the ventilation was good; Grade 3: visualization of all laryngeal inlet and partial glottis; Grade 4: full view of the glottisSaCoVLM -guided intubation (Fig. Intubation directly by SaCoVLM, the glottis was shown on the screen (Proper placement of the ETT was confirmed by the appearance of normal square wave capnogram and bilateral equal air entry. Time taken for intubation was recorded from the time of taking ETT in hand to the confirmation of proper placement of the ETT. During the procure, children were administered additional boluses of propofol (20–40 mg) to ensure adequate anesthetic depth.After successful intubation, the LMA was removed using a stabilizing rod(a plain tracheal tube one size smaller was used as a removal guide). Time taken for removal of the device was recorded as the disconnection of the breathing circuit till ventilation successfully. The attempt was terminated and the attempt classified as “failure” if total time exceeded 300 s or SpO2 decreased to < 91% and the trachea would be intubated by direct laryngoscopy if the device was not achieved correctly after three attempts, fiberoptic intubation through the device was not successful after two attempts, or if the tracheal tube was dislodged during device removal.Maintenance of anesthesia was realized using anesthetics (Oxygen+sevoflurane+propofol+remifentanil). Anesthetics were stopped at the end of surgery. Complications such as desaturation (SpO2 < 90%), regurgitation or aspiration, laryngospasm/bronchospasm, oropharyngeal or laryngeal trauma (blood staining of device/ETT) and hoarseness of voice were recorded. Patient follow-up was according to standard postoperative protocols at our institution.