Fiberoptic laryngoscopy under in neonates

In the Sophia Children’s Hospital we perform fiberoptic laryngoscopy in neonates under general anesthesia without the use of muscle relaxants in the diagnostics of functional laryngeal disorders. The necessary diagnostic and anesthetic equipment is described. Special attention is paid to the way in which the fiberscope is introduced into the breathing circuit and into the child’s airway. Several advantages over other methods are discussed. The procedure has proved to be easy, safe and informative. Introduction In Sophia Children’s Hospital 150-200 laryngo-bronchoscopies are performed annually for various diagnostic and therapeutic reasons. In all therapeutic and in many diagnostic procedures we prefer to use the rigid bronchoscope with a telescope. The patient is given general anesthesia and is ventilated. The procedure always involves administration of a muscle relaxant. However, in children presenting with an inspiratory stridor it is necessary to evaluate the function of the larynx. This is not possible if muscle relaxants have been given, so in these cases we have to use a different method. Direct laryngoscopy in a spontaneously breathing anesthetized child has the disadvantage of distortion of the larynx. Inserting the tip of the laryngoscope’s blade in the vallecula causes traction of the epiglottis, and consequently impedes Correspondence: L.J. Hoeve, Department of Otorhinolaryngology, Sophia Children’s Hospital, Gordelweg 160, 3038 GE Rotterdam, The Netherlands. 0165-5876/90/$03.50