Seldinger-Assisted Videotelescopic Intubation (SAVI): A Common Sense Approach to the Difficult Pediatric Airway

OBJECTIVES

To describe the Seldinger-assisted videotelescopic intubation (SAVI) technique, a complementary method for aiding in difficult pedi-atric intubations that uses common equipment available to the practicing otolaryngologist.

STUDY DESIGN

Technique description.

METHODS

Detailed description of technique for use of a pediatric laryngoscope with video-assisted endotracheal tube (ETT) covered rigid tracheoscopy controlled intubation in difficult pediatric airways.

RESULTS

In our practice, SAVI is vital in establishing a secure airway in the difficult-to-intubate child. After insertion of a laryngoscope, an appropriate sized endotracheal tube is delivered through the glottis under direct video-visualization from a rigid telescope using a variation of the well-established Seldinger technique. The telescope serves as the stable ETT stylet that also provides panoramic visualization. The ETT slides over the telescope to provide a secure airway directly visible to all in the operating room. Benefits of the SAVI technique to previously described video-assisted intubations with flexible or specially designed endoscope devices include decreased cost, employment of previously existing endoscopy skills, the benefit of rigid delivery of the endotracheal tube as well as innate versatility to a multitude of clinical situations.

CONCLUSIONS

The SAVI technique offers an additional practical clinical solution to the difficult pediatric airway. Although ultimately establishing the airway depends on the skills of the operator, the SAVI technique has saved multiple lives by using common equipment through a common-sense approach. EBM rating: D. (Otolaryngol Head Neck Surg 2005;132:677-680.)