![]() ![]() In airway evaluation, a small mouth and micrognathia were identified. His weight was 11 kg (0.44 percentile) and his height was 90 cm (7.8 percentile). In the preoperative evaluation for the implant of left cochlea, we discovered that he had growth and mental retardation, microtia, and postnasal drip. After one hour of several attempts, intubation was done successfully by laryngoscope with a straight blade using a wire-reinforced 4.5 mm internal diameter endotracheal tube. These were designed for adult patients and were too big for the child. ![]() Other attempts using a conventional blade of C-MAC ® video laryngoscope (Karl Storz, Germany) and fiberoptic bronchoscope (Olympus Ltd., Japan) failed. Fortunately, despite the grade 3 Cormack-Lehane classification, we could ventilate the child with a facial mask. Five well-experienced anesthesiologists tried intubation using a Macintosh laryngoscope about ten times but failed due to bilateral tonsillar hypertrophy and a very small epiglottis. We explained to his parents that there were several situations in which, if we could not ventilated the child, an emergency tracheostomy might be necessary, and if we could not intubate, we would have no choice but to postpone the surgery. ![]() At that time in this hospital, there were no special tools for difficult intubation of a child. He was first admitted to our hospital in 2016 for the implant of right cochlea. ![]()
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