Importance of Availability and Training in Video Laryngoscopy for Pediatric Surgery Residents – A Lesson from a Klippel–Feil Syndrome

Sir, We wish to highlight a critical airway safety concern that emerged in the pediatric surgery ward and emphasize the necessity of having video laryngoscopes readily available at all times for pediatric surgery residents. Additionally, we call for the implementation of structured training on their use. A 1-month-old baby with Klippel–Feil syndrome [Figure 1] suddenly dropped saturation to 85% in the pediatric surgery ward, which required immediate airway intervention. The surgical team tried to intubate the patient for the first time with a Miller size 1 laryngoscope, but they only got a Cormack–Lehane Grade 4 view, so endotracheal intubation was unsuccessful. They called the anesthesia team right away. The anesthesia team advised the surgical residents to oxygenate the child using an I-gel LMA size 1 until help arrived. On reaching the ward, the anesthesia team then successfully intubated the neonate using a C-MAC video laryngoscope with a size 0 Macintosh blade. This improved the view of the larynx to Cormack–Lehane Grade 1, which made intubation successful on the first attempt.[1] This case emphasizes three principal observations. First, video laryngoscopy greatly improves the ability to note the glottis in syndromic neonates.[2] This cuts down on failed attempts, hypoxia, airway trauma, and neurological problems. Second, surgery residents are often the first to respond to emergencies in the pediatric ward, so it is very important to have video laryngoscopes and proper training for safe airway management in infants with difficult airway. Third, early use of a laryngeal mask airway serves as an effective bridge until a definitive airway is secured. We strongly support the mandatory availability of video laryngoscopes in pediatric surgery wards and also advocate structured skill-based training. This will improve first-attempt success in emergency intubations, minimize morbidity, and enhance patient safety, particularly in neonates and syndromic children who present with anatomically challenging airways.Figure 1: Klippel–Feil syndrome with micrognathia and low-set earsDeclaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.