We present a novel technique for securing an endotracheal tube after using a #1 Classic laryngeal mask airway (LMA) as a conduit for intubating the trachea of a premature infant. During induction of anesthesia for inguinal hernia repair in an ex- 23-week infant, an unanticipated difficult airway was encountered. After several unsuccessful attempts of intubating via direct laryngoscopy, we placed the endotracheal tube (ETT) into the trachea using a fiberoptic bronchoscope through a #1 LMA. A pediatric stylette, with Hytape TM wrapped around the distal tip, was then used as a plunger to safely and easily remove the LMA from the mouth while maintaining the ETT in proper position. This technique is applicable in cases of a difficult neonatal airway where even a #1, the smallest LMA, is used.
Keywords: difficult neonatal intubation, laryngeal mask airway, fiberoptic intubation, difficult intubation