Which device is most appropriate for intubation in a child with laryngotracheal stenosis?

In cases of laryngotracheal stenosis, which can create significant challenges during intubation due to the narrowed airway, the flexible fiberoptic bronchoscope is often the most appropriate device. This technique allows for visualization of the airway and can facilitate intubation by navigating through the stenosis with a smaller, flexible instrument. The use of a fiberoptic scope can provide a clear view of the anatomy, which is particularly critical in a stenotic airway where traditional intubation methods may be ineffective or pose a higher risk for trauma.

The fiberoptic bronchoscope’s flexibility enables the provider to maneuver around tight areas while being able to visualize the approach, making it safer and often more effective in these complex scenarios. Additionally, it can help in identifying the appropriate size and type of endotracheal tube to use.

Other devices, such as laryngeal mask airways and various types of laryngoscopes, may not provide the necessary visualization and control needed in such a precarious situation where the airway is compromised. These devices may either lead to unsuccessful intubation attempts or cause injury to the already narrowed airway structures, whereas the fiberoptic technique prioritizes vision and precision.