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Akimaru S, Nakanishi T, Hasegawa T, Sobue K. Anesthetic Management of Inguinal Hernia Surgery Using a Second-Generation Supraglottic Airway in a Patient With Trisomy 18: A Case Report. Cureus 2023; 15:e45337. [PMID: 37849572 PMCID: PMC10577606 DOI: 10.7759/cureus.45337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2023] [Indexed: 10/19/2023] Open
Abstract
Children with trisomy 18 have abnormal airway anatomy, making their airway management challenging. Only a few papers have comprehensively described and discussed the use of supraglottic airway devices in patients with trisomy 18. We present a case of a 20-month-old boy with trisomy 18 who was scheduled for open repair of the right inguinal hernia. He had micrognathia, a short neck, and an atrial septal defect but was in a clinically stable condition. A supraglottic airway device was inserted under general anesthesia. The patient's respiration was maintained by pressure support ventilation with spontaneous breathing. A right ilioinguinal-iliohypogastric nerve block was performed for perioperative analgesia. The surgery ended without complications. After removing the supraglottic airway device and ensuring proper respiratory parameters, the patient was transferred to the post-anesthesia care unit. In our case, supraglottic airway devices could be effectively used as a primary airway for inguinal hernia repair. The concomitant ilioinguinal-iliohypogastric nerve block was helpful for anesthetic management with spontaneous breathing maintained using pressure support ventilation. A supraglottic airway device may be a potential alternative as a primary airway for superficial surgery in pediatric patients with trisomy 18. For pediatric patients with difficult airways, a second-generation supraglottic airway device with the insertion of a gastric tube to prevent gastric insufflation combining pressure support ventilation and positive end-expiratory pressure may be a beneficial choice for the maintenance of spontaneous breathing.
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Affiliation(s)
- Shintaro Akimaru
- Department of Anesthesiology and Intensive Care Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, JPN
| | - Toshiyuki Nakanishi
- Department of Anesthesiology and Intensive Care Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, JPN
| | - Tatsuya Hasegawa
- Department of Anesthesiology and Intensive Care Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, JPN
| | - Kazuya Sobue
- Department of Anesthesiology and Intensive Care Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, JPN
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Güth J, Jung P, Schiele A, Urban B, Parsch A, Matsche B, Eich C, Becke-Jakob K, Landsleitner B, Russo SG, Bernhard M, Hossfeld B, Olivieri M, Hoffmann F. [Update 2022: interdisciplinary statement on airway management with supraglottic airway devices in pediatric emergency medicine-The laryngeal mask is and remains state of the art : Joint statement of the Institute for Emergency Medicine and Medicine Management (INM), the University Clinic Munich, LMU Munich, Germany, the Working Group for Pediatric Critical Care and Emergency Medicine of the German Interdisciplinary Society for Critical Care and Emergency Medicine (DIVI), the Medical Directors of Emergency Medical Services in Bavaria (ÄLRD), the Scientific Working Group for Pediatric Anesthesia (WAKKA) of the German Society for Anesthesiology and Intensive Care Medicine (DGAI), the Scientific Working Group for Emergency Medicine of the German Society for Anesthesiology and Intensive Care Medicine (DGAI) and the Society of Neonatology and Pediatric Critical Care Medicine (GNPI)]. DIE ANAESTHESIOLOGIE 2023:10.1007/s00101-023-01284-2. [PMID: 37222766 DOI: 10.1007/s00101-023-01284-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 03/30/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND Airway management with supraglottic airway devices (SGA) in life-threatening emergencies in children is increasingly being used. Different specifications of laryngeal masks (LM) and the laryngeal tube (LT) are commonly used devices for this purpose. We present a literature review and interdisciplinary consensus statement of different societies on the use of SGA in pediatric emergency medicine. MATERIAL AND METHODS Literature review in the PubMed database and classification of studies according to the criteria of the Oxford Centre for Evidence-based Medicine. Levels and consensus finding within the group of authors. RESULTS The evidence for successful applications of the various types of LM is significantly higher than for LT application. Reported smaller series of successful applications of LT are currently limited to selected research groups and centers. Especially for children below 10 kg body weight there currently exists insufficient evidence for the successful application of the LT and therefore its routine use cannot be recommended. SGAs used for emergencies should have a gastric drainage possibility. DISCUSSION Considering the scientific data and the large clinical experience with the LM in medical routine and emergency situations in children currently only the LM can be recommended for alternative (i.e., non-intubation) emergency airway management in children. If alternative airway management is part of a local emergency strategy, the LM should be provided in all pediatric sizes (1, 1½, 2, 2½, 3) for out of hospital use and in hospital emergency use and all users should regularly be trained in its application.
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Affiliation(s)
- J Güth
- Institut für Notfallmedizin und Medizinmanagement (INM), Klinikum der Universität München, München, Deutschland
| | - P Jung
- Sektion Pädiatrische Intensiv- und Notfallmedizin, Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin, Deutschland
| | - A Schiele
- Ärztliche Leitung, Rettungsdienst Bayern (ÄLRD Bayern), München, Deutschland
| | - B Urban
- Institut für Notfallmedizin und Medizinmanagement (INM), Klinikum der Universität München, München, Deutschland
| | - A Parsch
- Ärztliche Leitung, Rettungsdienst Bayern (ÄLRD Bayern), München, Deutschland
| | - B Matsche
- Ärztliche Leitung, Rettungsdienst Bayern (ÄLRD Bayern), München, Deutschland
| | - C Eich
- Sektion Pädiatrische Intensiv- und Notfallmedizin, Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin, Deutschland
- Wissenschaftlicher Arbeitskreis Kinderanästhesie (WAKKA), Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), Nürnberg, Deutschland
| | - K Becke-Jakob
- Wissenschaftlicher Arbeitskreis Kinderanästhesie (WAKKA), Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), Nürnberg, Deutschland
| | - B Landsleitner
- Sektion Pädiatrische Intensiv- und Notfallmedizin, Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin, Deutschland
- Wissenschaftlicher Arbeitskreis Kinderanästhesie (WAKKA), Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), Nürnberg, Deutschland
| | - S G Russo
- Wissenschaftlicher Arbeitskreis Kinderanästhesie (WAKKA), Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), Nürnberg, Deutschland
| | - M Bernhard
- Wissenschaftlicher Arbeitskreis Notfallmedizin, Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), Nürnberg, Deutschland
| | - B Hossfeld
- Sektion Pädiatrische Intensiv- und Notfallmedizin, Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin, Deutschland
| | - M Olivieri
- Sektion Pädiatrische Intensiv- und Notfallmedizin, Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin, Deutschland
| | - F Hoffmann
- Sektion Pädiatrische Intensiv- und Notfallmedizin, Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin, Deutschland.
- Gesellschaft für Neonatologie und Pädiatrische Intensivmedizin (GNPI), Berlin, Deutschland.
- Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital, Institut für Notfallmedizin und Medizinmanagement (INM), Ludwig-Maximilians-Universität München, Lindwurmstr. 4, 80337, München, Deutschland.
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Schmucker Agudelo E, Farré Pinilla M, Andreu Riobello E, Franco Castanys T, Villaverde Castillo I, Monclus Diaz E, Aragonés Panadés N, Muñoz Luz A. An update in paediatric airway management. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2022; 69:472-486. [PMID: 36096882 DOI: 10.1016/j.redare.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 05/25/2021] [Indexed: 06/15/2023]
Affiliation(s)
- E Schmucker Agudelo
- Hospital Universitario Vall d'Hebrón, Área Materno Infantil, Barcelona, Spain.
| | | | - E Andreu Riobello
- Hospital Universitario Vall d'Hebrón, Área Materno Infantil, Barcelona, Spain
| | | | | | | | | | - A Muñoz Luz
- Hospital Universitario Dr. Josep Trueta, Girona, Spain
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Efficacy of I- gel™ for airway management of neonates with Pierre Robin sequence undergoing glossopexy: A prospective study. J Craniomaxillofac Surg 2022; 50:569-575. [PMID: 35787956 DOI: 10.1016/j.jcms.2022.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 04/19/2022] [Accepted: 05/30/2022] [Indexed: 11/20/2022] Open
Abstract
This paper aims to review the utility of I- gel as a successful airway management device for infants with Pierre robin sequence (PRS) undergoing glossopexy. A prospective study was conducted on PRS neonates. The algorithm followed was putting a 'Tongue traction stitch' followed by the following sequence - two trials with direct laryngoscope intubation, two attempts with fiberoptic endoscope intubation followed by insertion of I-gel™ to manage difficult airway during glossopexy procedure. 6 patients were intubated with direct laryngoscope, 12 patients were intubated with fibreoptic endoscope and the rest 13 patients were intubated using I-gel™. Successful management of difficult airway was achieved with this airway management protocol during glossopexy and nil postoperative complications were encountered. Within the limitations of the study it seems that, I-gel™ is a relevant alternative toprovide a reliable and secure airway access to carry out glossopexy procedure in such patients.
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Endlich Y, Hore PJ, Baker PA, Beckmann LA, Bradley WP, Chan KLE, Chapman GA, Jephcott CGA, Kruger PS, Newton A, Roessler P. Updated guideline on equipment to manage difficult airways: Australian and New Zealand College of Anaesthetists. Anaesth Intensive Care 2022; 50:430-446. [PMID: 35722809 DOI: 10.1177/0310057x221082664] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The Australian and New Zealand College of Anaesthetists (ANZCA) recently reviewed and updated the guideline on equipment to manage a difficult airway. An ANZCA-established document development group, which included representatives from the Australasian College for Emergency Medicine and the College of Intensive Care Medicine of Australia and New Zealand, performed the review, which is based on expert consensus, an extensive literature review, and bi-nationwide consultation. The guideline (PG56(A) 2021, https://www.anzca.edu.au/getattachment/02fe1a4c-14f0-4ad1-8337-c281d26bfa17/PS56-Guideline-on-equipment-to-manage-difficult-airways) is accompanied by a detailed background paper (PG56(A)BP 2021, https://www.anzca.edu.au/getattachment/9ef4cd97-2f02-47fe-a63a-9f74fa7c68ac/PG56(A)BP-Guideline-on-equipment-to-manage-difficult-airways-Background-Paper), from which the current recommendations are reproduced on behalf of, and with the permission of, ANZCA. The updated 2021 guideline replaces the 2012 version and aims to provide an updated, objective, informed, transparent, and evidence-based review of equipment to manage difficult airways.
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Affiliation(s)
- Yasmin Endlich
- Department of Anaesthesia and Acute Pain Medicine, Royal Adelaide Hospital, Adelaide, Australia.,Department of Paediatric Anaesthesia, Women's and Children's Hospital, North Adelaide, Australia.,Faculty of Anaesthesia, University of Adelaide, Adelaide, Australia
| | - Phillipa J Hore
- Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital, Melbourne, Australia
| | - Paul A Baker
- Department of Anaesthesiology, University of Auckland, Auckland, New Zealand.,Department of Anaesthesia, Starship Children's Hospital, Auckland, New Zealand
| | - Linda A Beckmann
- Department of Anaesthesia and Acute Pain Medicine, Royal Brisbane and Women's Hospital, Herston, Australia
| | - William P Bradley
- Department of Anaesthesia and Perioperative Medicine, The Alfred, Melbourne, Australia.,Faculty of Anaesthesia, Monash University, Melbourne, Australia
| | - Kah L E Chan
- Department of Anaesthesia and Acute Pain Medicine, Royal Brisbane and Women's Hospital, Herston, Australia
| | - Gordon A Chapman
- Department of Anaesthesia, Royal Perth Hospital, Perth, Australia.,Faculty of Anaesthesia, University of Western Australia, Perth, Australia
| | | | - Peter S Kruger
- Department of Intensive Care Medicine, Princess Alexandra Hospital, Brisbane, Australia
| | - Alastair Newton
- Department of Emergency Medicine, The Prince Charles Hospital, Brisbane, Australia.,Retrieval Services Queensland, Brisbane, Australia
| | - Peter Roessler
- Safety and Advocacy Unit, Australian and New Zealand College of Anaesthetists, Melbourne, Australia
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Unal D, Hazir MS. Review Airway management in pediatric patients with burn contractures of the face and neck. J Burn Care Res 2022; 43:1186-1202. [PMID: 35137105 DOI: 10.1093/jbcr/irac016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Burn injury is a common cause of trauma, non-fatal burn injuries are a leading cause of morbidity, and significant numbers of the victims are children. Scar contracture after burn injury can cause severe functional limitation, pain, aesthetic and psychological problems and patients may present for contracture release and reconstructive surgery. The aim of this systematic review was to identify research relevant to airway management of children with burn contracture of the face and neck with special emphasis on awake airway management and airway anesthesia, and synthesize results that can aid practice. Literature search was performed on Medline, PubMed, Cochrane Library, and Google Scholar with selected keywords. The search was restricted to human subjects of ≤18 year age, there was no language or time restriction and the final search was concluded in July 2021. The review included 41 articles involving airway management of 56 patients in 61 anesthesia episodes. Patients aged between 8 months to 18 years. Mask ventilation and direct laryngoscopy, video laryngoscopy, optical stylet, supraglottic airway, flexible scope intubation and tracheostomy, and extracorporeal membrane oxygenation were the devices and methods used for securing the airway and oxygenation while the patients were awake or after anesthesia induction. Detailed planning and patient preparation are the fundamentals of airway management of pediatric patients with burn contracture of the face and neck, awake airway management with airway anesthesia can be safely used in selected patients, this review provides information for good clinical practice and might serve to improve the care of such children.
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Affiliation(s)
- Dilek Unal
- Department of Anesthesiology and Reanimation, University of Health Sciences Diskapi Yildirim Beyazit Teaching Hospital, Ankara, Turkey
| | - Melis Sumak Hazir
- Department of Anesthesiology and Reanimation, University of Health Sciences Diskapi Yildirim Beyazit Teaching Hospital, Ankara, Turkey
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Harris M, Lyng JW, Mandt M, Moore B, Gross T, Gausche-Hill M, Donofrio-Odmann JJ. Prehospital Pediatric Respiratory Distress and Airway Management Interventions: An NAEMSP Position Statement and Resource Document. PREHOSP EMERG CARE 2022; 26:118-128. [PMID: 35001823 DOI: 10.1080/10903127.2021.1994675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Devices and techniques such as bag-valve-mask ventilation, endotracheal intubation, supraglottic airway devices, and noninvasive ventilation offer important tools for airway management in critically ill EMS patients. Over the past decade the tools, technology, and strategies used to assess and manage pediatric respiratory and airway emergencies have evolved, and evidence regarding their use continues to grow.NAEMSP recommends:Methods and tools used to properly size pediatric equipment for ages ranging from newborns to adolescents should be available to all EMS clinicians. All pediatric equipment should be routinely checked and clearly identifiable in EMS equipment supply bags and vehicles.EMS agencies should train and equip their clinicians with age-appropriate pulse oximetry and capnography equipment to aid in the assessment and management of pediatric respiratory distress and airway emergencies.EMS agencies should emphasize noninvasive positive pressure ventilation and effective bag-valve-mask ventilation strategies in children.Supraglottic airways can be used as primary or secondary airway management interventions for pediatric respiratory failure and cardiac arrest in the EMS setting.Pediatric endotracheal intubation has unclear benefit in the EMS setting. Advanced approaches to pediatric ETI including drug-assisted airway management, apneic oxygenation, and use of direct and video laryngoscopy require further research to more clearly define their risks and benefits prior to widespread implementation.If considering the use of pediatric endotracheal intubation, the EMS medical director must ensure the program provides pediatric-specific initial training and ongoing competency and quality management activities to ensure that EMS clinicians attain and maintain mastery of the intervention.Paramedic use of direct laryngoscopy paired with Magill forceps to facilitate foreign body removal in the pediatric patient should be maintained even when pediatric endotracheal intubation is not approved as a local clinical intervention.
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Apfelbaum JL, Hagberg CA, Connis RT, Abdelmalak BB, Agarkar M, Dutton RP, Fiadjoe JE, Greif R, Klock PA, Mercier D, Myatra SN, O'Sullivan EP, Rosenblatt WH, Sorbello M, Tung A. 2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway. Anesthesiology 2022; 136:31-81. [PMID: 34762729 DOI: 10.1097/aln.0000000000004002] [Citation(s) in RCA: 352] [Impact Index Per Article: 176.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The American Society of Anesthesiologists; All India Difficult Airway Association; European Airway Management Society; European Society of Anaesthesiology and Intensive Care; Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care; Learning, Teaching and Investigation Difficult Airway Group; Society for Airway Management; Society for Ambulatory Anesthesia; Society for Head and Neck Anesthesia; Society for Pediatric Anesthesia; Society of Critical Care Anesthesiologists; and the Trauma Anesthesiology Society present an updated report of the Practice Guidelines for Management of the Difficult Airway.
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9
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Dhar R, Sofi K, Mir SA, Jehangir M, Wazir M. Comparison of Spontaneous Ventilation, Pressure Control Ventilation and Pressure Support Ventilation in Pediatric Patients Undergoing Infraumbilical Surgery Using ProSeal Laryngeal Mask Airway. Anesth Essays Res 2021; 15:321-326. [PMID: 35320969 PMCID: PMC8936875 DOI: 10.4103/aer.aer_120_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/01/2021] [Indexed: 11/30/2022] Open
Abstract
Background: Pediatric infraumbilical surgeries are often performed under general anaesthesia using different modes of ventilation through Laryngeal Mask Airway .Although controlled ventilation has been successfully used, very less studies have been done to compare them with spontaneous ventilation for short duration surgeries. Aims: We tried to measure quantitave differences in haemodynamic and respiratory parameters and assess the recovery profile between controlled and spontaneous ventilation using Proseal LMA. Settings and Design: This was a prospective, randomized, double-blind study that comprised 90 American Society of Anaesthesiologist (ASA) classes I and II pediatric patients posted for infra umbilical surgery. Materials and Methods: 90 paediatric patients undergoing infraumbilical surgeries were included. Three different ventilation strategies: spontaneous , pressure support and pressure-controlled ventilation were applied depending on attending anaesthesiologist's preference. Haemodynamic and respiratory parameters were recorded during the procedure. Post procedure parameters including need for supplementary oxygen, recovery time, complications were recorded. Statistical Methods: Analysis of variance (ANOVA) was employed for inter group analysis and for multiple comparisons, least significant difference (LSD) test was applied. Chi-square test or Fisher's exact test, whichever appropriate, was used for comparison of categorical variables. Results: The mean time interval between end of surgery and removal of LMA was significantly higher in PCV group in comparison to SV and PSV groups. In SV group lesser number of patients required oxygen supplementation and had shorter stay in recovery than PCV group. Conclusion: We conclude that spontaneous mode of ventilation can be used as safely as controlled /assist ventilation mode in short duration surgeries in high turn over settings.
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Affiliation(s)
- Rohini Dhar
- Department of Anesthesiology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Khalid Sofi
- Department of Anesthesiology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Shafat Ahmad Mir
- Department of Anesthesiology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Majid Jehangir
- Department of Anesthesiology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Mohsin Wazir
- Department of Anesthesiology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
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Jagannathan N, Asai T. Difficult airway management: children are different from adults, and neonates are different from children! Br J Anaesth 2021; 126:1086-1088. [PMID: 33867047 DOI: 10.1016/j.bja.2021.03.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 03/17/2021] [Accepted: 03/17/2021] [Indexed: 12/19/2022] Open
Affiliation(s)
- Narasimhan Jagannathan
- Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
| | - Takashi Asai
- Department of Anesthesiology, Dokkyo Medical University Saitama Medical Centre, Koshigaya, Saitama, Japan
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A randomized controlled trial to compare the auricle size-based method for ProSeal laryngeal mask airway selection with the weight-based method among paediatric patients. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2021. [DOI: 10.1016/j.tacc.2020.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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12
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Allahyari E, Azimi A, Zarei H, Bamdad S. Comparison of endotracheal intubation, laryngeal mask airway, and I-gel in children undergoing strabismus surgery. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2021; 26:9. [PMID: 34084188 PMCID: PMC8103961 DOI: 10.4103/jrms.jrms_325_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 11/03/2019] [Accepted: 08/27/2020] [Indexed: 11/04/2022]
Abstract
Background Insertion of the advanced airway during induction of general anesthesia can cause undesirable sympathetic stimulation such as increased intraocular pressure (IOP) and hemodynamic parameters. In this study, we compared insertion of three different advanced airway devices; endotracheal tube (ETT), laryngeal mask airway (LMA) and I-gel in terms of IOP, hemodynamic changes and postoperative nausea and vomiting (PONV) following induction of general anesthesia with propofol and remifentanil in children undergoing strabismus surgery. Materials and Methods A total of 90 children (5.68 ± 1.49 years old) were randomly assigned to one of the three groups, ETT, LMA, or I-gel insertion as advanced airway devices IOP and also hemodynamic variables were measured before (T0 and T1) and immediately after (T2) the insertion of these airway devices, although 2 min (T3) and 5 min (T4) after it. PONV was assessed about 2 h after the completion of surgery in the recovery room. Results The mean arterial pressure (MAP), IOP, and systolic and diastolic blood pressures were significantly different between the three groups immediately (T2), 2 min (T3), and 5 min (T4) after the insertion of airway devices. The heart rate (HR) was significantly different between the three groups in all measurement times except of T0. Within-group comparisons showed that the three groups had significant changes in MAP, IOP, HR, systolic and diastolic pressure before and after airway insertion (T1 and T2). The trend in the LMA and ETT groups was descending-ascending-descending, whereas in the I-gel group, it was quite descending. There was no significant difference among the three groups in terms of PONV. Conclusion As a result, our study showed that, compared with LMA and ETT, the I-gel had less impact on undesirable stress responses and seems to be superior to LMA and ETT in children undergoing strabismus surgery.
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Affiliation(s)
- Elaheh Allahyari
- Shiraz Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Azimi
- Poostchi Ophthalmology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamed Zarei
- Shiraz Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shahram Bamdad
- Poostchi Ophthalmology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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13
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Mileder LP, Derler T, Baik-Schneditz N, Schwaberger B, Urlesberger B, Pichler G. Optimizing noninvasive respiratory support during postnatal stabilization: video-based analysis of airway maneuvers and their effects. J Matern Fetal Neonatal Med 2020; 35:3991-3997. [PMID: 33172322 DOI: 10.1080/14767058.2020.1846176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Noninvasive respiratory support during postnatal transition may be challenging. Thus, we aimed to analyze frequency and effects of maneuvers to improve noninvasive respiratory support in neonates immediately after birth. MATERIALS AND METHODS We included neonates born between September 2009 and January 2015 who were video recorded as part of prospective observational studies and required noninvasive respiratory support during the first 15 min after birth. Maneuvers to improve respiratory support were assessed by video analysis. Vital parameter measurement using pulse oximetry and near-infrared spectroscopy was supplemented by respiratory function monitoring. RESULTS One-hundred forty-three of 653 eligible neonates (21.9%) required respiratory support. Video recordings were analyzed in 76 preterm and 58 term neonates, showing airway maneuvers in 105 of them (78.4%). Repositioning of the face mask was the most common maneuver (56.9%). We observed a median of three maneuvers (0-22) in preterm and a median of two maneuvers (0-13) in term neonates (p = .01). Regional cerebral tissue oxygen saturation was significantly higher during the 60 s after the first airway maneuver. CONCLUSION Maneuvers to improve respiratory support are commonly required during neonatal resuscitation, with a higher incidence in preterm neonates. The first airway maneuver was associated with an improvement of cerebral tissue oxygenation.
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Affiliation(s)
- Lukas P Mileder
- Research Unit for Neonatal Micro- and Macrocirculation, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria.,Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Tanja Derler
- Research Unit for Neonatal Micro- and Macrocirculation, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Nariae Baik-Schneditz
- Research Unit for Neonatal Micro- and Macrocirculation, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria.,Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Bernhard Schwaberger
- Research Unit for Neonatal Micro- and Macrocirculation, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria.,Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Berndt Urlesberger
- Research Unit for Neonatal Micro- and Macrocirculation, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria.,Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Gerhard Pichler
- Research Unit for Neonatal Micro- and Macrocirculation, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria.,Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
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14
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Gasteiger L, Oswald E, Keplinger M, Putzer G, Luger M, Neururer S, Keller C, Moser B. A randomized trial comparing the Ambu® Aura-i™ and the Ambu® Aura Gain™ laryngeal mask as conduit for tracheal intubation in children. Minerva Anestesiol 2020; 86:1143-1150. [DOI: 10.23736/s0375-9393.20.14422-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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15
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Evaluation of Different Positive End-Expiratory Pressures Using Supreme™ Airway Laryngeal Mask during Minor Surgical Procedures in Children. ACTA ACUST UNITED AC 2020; 56:medicina56100551. [PMID: 33096743 PMCID: PMC7589667 DOI: 10.3390/medicina56100551] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/09/2020] [Accepted: 10/19/2020] [Indexed: 11/29/2022]
Abstract
Background and objectives: The laryngeal mask is the method of choice for airway management in children during minor surgical procedures. There is a paucity of data regarding optimal management of mechanical ventilation in these patients. The Supreme™ airway laryngeal mask offers the option to insert a gastric tube to empty the stomach contents of air and/or gastric juice. The aim of this investigation was to evaluate the impact of positive end-expiratory positive pressure (PEEP) levels on ventilation parameters and gastric air insufflation during general anesthesia in children using pressure-controlled ventilation with laryngeal mask. Materials and Methods: An observational trial was carried out in 67 children aged between 1 and 11 years. PEEP levels of 0, 3 and 5 mbar were tested for 5 min in each patient during surgery and compared with ventilation parameters (dynamic compliance (mL/cmH2O), etCO2 (mmHg), peak pressure (mbar), tidal volume (mL), respiratory rate (per minute), FiO2 and gastric air (mL)) were measured at each PEEP. Air was aspirated from the stomach at the start of the sequence of measurements and at the end. Results: Significant differences were observed for the ventilation parameters: dynamic compliance (PEEP 5 vs. PEEP 3: p < 0.0001, PEEP 5 vs. PEEP 0: p < 0.0001, PEEP 3 vs. PEEP 0: p < 0.0001), peak pressure (PEEP 5 vs. PEEP 3: p < 0.0001, PEEP 5 vs. PEEP 0: p < 0.0001, PEEP 3 vs. PEEP 0: p < 0.0001) and tidal volume (PEEP 5 vs. PEEP 3: p = 0.0048, PEEP 5 vs. PEEP 0: p < 0.0001, PEEP 3 vs. PEEP 0: p < 0.0001). All parameters increased significantly with higher PEEP, with the exception of etCO2 (significant decrease) and respiratory rate (no significant difference). We also showed different values for air quantity in the comparisons between the different PEEP levels (PEEP 5: 2.8 ± 3.9 mL, PEEP 3: 1.8 ± 3.0 mL; PEEP 0: 1.6 ± 2.3 mL) with significant differences between PEEP 5 and PEEP 3 (p = 0.0269) and PEEP 5 and PEEP 0 (p = 0.0209). Conclusions: Our data suggest that ventilation with a PEEP of 5 mbar might be more lung protective in children using the Supreme™ airway laryngeal mask, although gastric air insufflation increased with higher PEEP. We recommend the use of a laryngeal mask with the option of inserting a gastric tube to evacuate potential gastric air.
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16
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Huang AS, Sarver A, Widing A, Hajduk J, Jagannathan N. The design of the perfect pediatric supraglottic airway device. Paediatr Anaesth 2020; 30:280-287. [PMID: 31837186 DOI: 10.1111/pan.13785] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 11/29/2019] [Accepted: 12/06/2019] [Indexed: 11/28/2022]
Abstract
The design evolution of the pediatric supraglottic airway device has experienced a long and productive journey. We have a wealth of clinical studies to support progress and advancements in pediatric clinical practice. While all of the supraglottic airway devices have been used successfully in millions of children, it is important to be aware of design advantages and disadvantages of the different models of supraglottic airway devices. Current pediatric supraglottic airway devices may be improved in design to be more ideal. Industry-changing technological advancements are likely to occur in the near future, which may further improve clinical performance of these devices.
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Affiliation(s)
- Andrea S Huang
- Department of Pediatric Anesthesia, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ashley Sarver
- Department of Pediatric Anesthesia, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Amanda Widing
- Department of Pediatric Anesthesia, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - John Hajduk
- Department of Pediatric Anesthesia, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Narasimhan Jagannathan
- Department of Pediatric Anesthesia, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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17
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Murray DJ, Massy-Westropp C, Narayana-Reddy K, Marsh J. Description and function of a difficult airway service. Paediatr Anaesth 2020; 30:375-382. [PMID: 31828907 DOI: 10.1111/pan.13783] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 12/06/2019] [Indexed: 11/29/2022]
Abstract
The goal of the Pediatric Difficult Airway Service (DAS) is to improve the care of children with airway abnormalities primarily through identification of children at risk for failed airway management. The airway service encourages early recognition and provides consultation, a plan for airway management, expertise in airway management, and follow-up care for children who have a difficult airway. The service has improved the education of healthcare professionals and heightened awareness about the consequences of failed airway management.
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Affiliation(s)
- David J Murray
- Division of Pediatric Anesthesiology, Department of Anesthesiology, Howard and Joyce Wood Simulation Center, Washington University School of Medicine, St Louis, MO, USA
| | - Collette Massy-Westropp
- Division of Pediatric Anesthesiology, Department of Anesthesiology, Howard and Joyce Wood Simulation Center, Washington University School of Medicine, St Louis, MO, USA
| | - Kavya Narayana-Reddy
- Division of Pediatric Anesthesiology, Department of Anesthesiology, Howard and Joyce Wood Simulation Center, Washington University School of Medicine, St Louis, MO, USA
| | - Jennifer Marsh
- Division of Pediatric Anesthesiology, Department of Anesthesiology, Howard and Joyce Wood Simulation Center, Washington University School of Medicine, St Louis, MO, USA
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18
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Santambrogio L, Righi S, Pinciroli RL, Piro E, D’alessio A, Minuto A. Instrumental and randomised clinical comparison between laryngeal mask airway Proseal and Supreme in pediatric patients. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2020. [DOI: 10.1016/j.tacc.2019.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Cobo P, Vetter-Laracy S, Beltran E, Peña-Zarza JA, Figuerola J, Osona B. Utility of fiberoptic bronchoscopy for difficult airway in neonates. J Matern Fetal Neonatal Med 2019; 34:2754-2757. [PMID: 31575302 DOI: 10.1080/14767058.2019.1670801] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Newborns diagnosed with craniofacial malformations or laryngeal and tracheal alterations may often need advanced airway-management for airway stabilization. Although fiberoptic bronchoscopy (FB) is currently the gold standard for difficult airway management, there is a scarcity of published data on the application of FB in newborns for intubation and controlled extubation (CE). OBJECTIVES This study describes a case series where FB is used for intubation and/or extubation to manage newborns with difficult airway in either urgent procedures or scheduled ones. METHODS All FB were carried out on newborns with difficult airway in the neonatal unit over the period January 2005 to December 2018. Patient characteristics were collected from clinical reports, description of the technique from the procedure report. RESULTS 66 FBs were performed from a total of 40 newborns, a median age of 25 days and a weight of 3217 g. Eighteen were ex-premature babies (45%). Six (15%) had craniocervical malformations. 17 (25.7%) FBs were performed for tracheal intubation (TI), 6 in emergency situations, 34 (51.5%) for CE, and 15 (22.7%) for precise tube placement. Clearing of the airway was achieved in all cases and thus there were no failed TIs. In 32 cases (94.1%), CE was successfully performed. In 6 cases, withdrawal of the ET midprocedure was decided to postpone as 4 of these required extra treatment prior to renewed extubation attempt and 2 needed a tracheostomy. 2 patients required subsequent FB reintubation due to airway pathology. Complications during the procedure were mild desaturations (3%) and deep desaturations (7.5%). CONCLUSIONS FB is very safe and highly useful when performing intubation in neonates with difficult airway but is essential during extubation to avoid any risk of failure with a potentially fatal outcome. Neonatal units of tertiary hospitals should provide equipment and training to manage these neonates. WHAT IS ALREADY KNOWN? A failed intubation or extubation can lead to cardiac arrest and anoxic brain damage and/or to death in a neonate. Fiberoptic bronchoscopy is recommended as the safest tool for neonates with difficult airway. However, there is little concrete data published in the current literature to support the recommendations. WHAT IS NEW Fiberoptic bronchoscopy is an essential tool to avoid the risk of a failed extubation in neonates with difficult airway.
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Affiliation(s)
- Pilar Cobo
- Division of Neonatology, Department of Pediatrics, University Hospital Son Espases, Palma de Mallorca, Spain.,Pediatric Multidisciplinary Research Group of Balearic Islands Health Research Institute (IdISBa), Palma de Mallorca, Spain
| | - Susanne Vetter-Laracy
- Division of Neonatology, Department of Pediatrics, University Hospital Son Espases, Palma de Mallorca, Spain.,Pediatric Multidisciplinary Research Group of Balearic Islands Health Research Institute (IdISBa), Palma de Mallorca, Spain
| | - Eva Beltran
- Division of Neonatology, Department of Pediatrics, University Hospital Son Espases, Palma de Mallorca, Spain.,Pediatric Multidisciplinary Research Group of Balearic Islands Health Research Institute (IdISBa), Palma de Mallorca, Spain
| | - José Antonio Peña-Zarza
- Department of Pediatrics, Division of Pediatric Respiratory Medicine, University Hospital Son Espases, Palma de Mallorca, Spain.,Sleep Apneas and Hypopneas Research Group of Balearic Islands Health Research Institute (IdISBa), Palma de Mallorca, Spain
| | - Joan Figuerola
- Pediatric Multidisciplinary Research Group of Balearic Islands Health Research Institute (IdISBa), Palma de Mallorca, Spain.,Department of Pediatrics, Division of Pediatric Respiratory Medicine, University Hospital Son Espases, Palma de Mallorca, Spain
| | - Borja Osona
- Pediatric Multidisciplinary Research Group of Balearic Islands Health Research Institute (IdISBa), Palma de Mallorca, Spain.,Department of Pediatrics, Division of Pediatric Respiratory Medicine, University Hospital Son Espases, Palma de Mallorca, Spain
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20
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Current Concepts in the Management of the Difficult Pediatric Airway. CURRENT ANESTHESIOLOGY REPORTS 2019. [DOI: 10.1007/s40140-019-00319-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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21
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Dadure C, Sabourdin N, Veyckemans F, Babre F, Bourdaud N, Dahmani S, Queiroz MD, Devys JM, Dubois MC, Kern D, Laffargue A, Laffon M, Lejus-Bourdeau C, Nouette-Gaulain K, Orliaguet G, Gayat E, Velly L, Salvi N, Sola C. Management of the child's airway under anaesthesia: The French guidelines. Anaesth Crit Care Pain Med 2019; 38:681-693. [PMID: 30807876 DOI: 10.1016/j.accpm.2019.02.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To provide French guidelines about "Airway management during paediatric anaesthesia". DESIGN A consensus committee of 17 experts from the French Society of Anaesthesia and Intensive Care Medicine (Société Française d'Anesthésie-Réanimation, SFAR) and the Association of French speaking paediatric anaesthesiologists and intensivists (Association Des Anesthésistes Réanimateurs Pédiatriques d'Expression Francophone, ADARPEF) was convened. The entire process was conducted independently of any industry funding. The authors followed the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE®) system to assess the quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasised. Few recommendations were not graded. METHODS The panel focused on 7 questions: 1) Supraglottic Airway devices 2) Cuffed endotracheal tubes 3) Videolaryngoscopes 4) Neuromuscular blocking agents 5) Rapid sequence induction 6) Airway device removal 7) Airway management in the child with recent or ongoing upper respiratory tract infection. Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. The analysis of the literature and the redaction of the recommendations were then conducted according to the GRADE® methodology. RESULTS The SFAR Guideline panel provides 17 statements on "airway management during paediatric anaesthesia". After two rounds of discussion and various amendments, a strong agreement was reached for 100% of the recommendations. Of these recommendations, 6 have a high level of evidence (Grade 1 ± ), 6 have a low level of evidence (Grade 2 ± ) and 5 are experts' opinions. No recommendation could be provided for 3 questions. CONCLUSIONS Substantial agreement exists among experts regarding many strong recommendations for paediatric airway management.
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Affiliation(s)
- Christophe Dadure
- Département d'anesthesiologie réanimation femme-mère-enfant, CHU de Lapeyronie, institut de génomique fonctionnelle, UMR 5203 CNRS - U 1191 Inserm, université de Montpellier, 34285 Montpellier, France.
| | - Nada Sabourdin
- Département d'anesthésiologie-réanimation hôpital Armand Trousseau, AP-HP, 26, avenue du Dr Arnold-Netter, 75012 Paris, France
| | - Francis Veyckemans
- Department of paediatric anaesthesia, Jeanne de Flandre hospital, university hospitals of Lille, 59037 Lille, France
| | - Florence Babre
- Department of anaesthesia, Bergonié institute, 33000 Bordeaux, France
| | - Nathalie Bourdaud
- Département d'Anesthésiologie Réanimation Pédiatrique, Hôpital Femme Mère Enfant, 69677 Bron, France
| | - Souhayl Dahmani
- Department of anaesthesia and intensive care. Robert-Debré university hospital, assistance publique Hôpitaux de Paris, Paris Diderot University, Paris Sorbonne Cité, Paris, Paris Diderot University (Paris VII), PRES Paris Sorbonne Cité, Paris, DHU PROTECT, Inserm U1141, Robert-Debré University Hospital, 75019 Paris, France
| | - Mathilde De Queiroz
- Département d'Anesthésiologie Réanimation Pédiatrique, Hôpital Femme Mère Enfant, 69677 Bron, France
| | - Jean-Michel Devys
- Service d'anesthésie-réanimation, fondation ophtalmologique Adolphe de Rothschild, 25, rue Manin, 75019 Paris, France
| | - Marie-Claude Dubois
- Service d'anesthésie-réanimation, fondation ophtalmologique Adolphe de Rothschild, 25, rue Manin, 75019 Paris, France
| | - Delphine Kern
- Departments of anaesthesia and intensive care, university hospital of Toulouse, place du Dr Baylac, TSA 40031, 31059 Toulouse cedex 9, France
| | - Anne Laffargue
- Department of paediatric anaesthesia, Jeanne de Flandre hospital, university hospitals of Lille, 59037 Lille, France
| | - Marc Laffon
- Department of anesthesia and intensive care, university hospital and medical university François-Rabelais, Tours, France
| | - Corinne Lejus-Bourdeau
- Service d'anesthesie réanimation chirurgicale, Hôtel Dieu, Hôpital Mère Enfant, CHU de Nantes, 44093 Nantes cedex, France
| | - Karine Nouette-Gaulain
- Service d'anesthésie réanimation Pellegrin, hôpital Pellegrin, CHU de Bordeaux, place Amélie Raba Léon, 33000 Bordeaux, France; Université Bordeaux, Inserm U12-11, laboratoire de maladies rares: génétique et métabolisme (MRGM), 176, rue Léo-Saignat, 33000 Bordeaux, France
| | - Gilles Orliaguet
- Department of anaesthesia and intensive care, assistance publique Hôpitaux de Paris, Necker-Enfants Malades hospital, EA08 pharmacologie et évaluation des thérapeutiques chez l'enfant et la femme enceinte, Paris Descartes University (Paris V), PRES Paris Sorbonne Cité, 75743 Paris, France
| | - Etienne Gayat
- Department of anesthesiology and Intensive care, Saint Louis, Lariboisière university hospital, université Paris Diderot, BioCANVAS, UMR-S 942, Inserm, 75010 Paris, France
| | - Lionel Velly
- Service d'anesthesie réanimation, CHU de Timone adultes, 264, rue St Pierre, 13005 MeCA, institut de neurosciences de la Timone, UMR 7289, Aix Marseille université, Marseille, France
| | - Nadège Salvi
- Department of anaesthesia and intensive care, assistance publique Hôpitaux de Paris, Necker-Enfants Malades Hospital, 75743 Paris, France
| | - Chrystelle Sola
- Département d'anesthesiologie réanimation femme-mère-enfant, CHU de Lapeyronie, institut de génomique fonctionnelle, UMR 5203 CNRS - U 1191 Inserm, université de Montpellier, 34285 Montpellier, France
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22
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Ravi R, Mohan VK, Badhe AS, Mishra SK, Bidkar PU. Comparison of weight-based and pinna size-based selection of ProSeal laryngeal mask airway in paediatric population - A prospective exploratory trial. Indian J Anaesth 2019; 63:36-41. [PMID: 30745611 PMCID: PMC6341894 DOI: 10.4103/ija.ija_423_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background and Aims Weight-based selection of ProSeal laryngeal mask airway (PLMA) size may be unreliable in some situations. The aim of this study was to compare the ventilation parameters using PLMA during controlled ventilation between weight-based size selection and pinna size-based selection in children. Methods A total of 204 patients were randomised to receive either pinna size-based (Group P) or weight-based (Group W) size selection of PLMA. We tested the hypothesis that pinna size-based selection of PLMA was better than weight-based selection of PLMA in paediatric patients during controlled ventilation under general anaesthesia in terms of oropharyngeal sealing pressure (the primary end-point) and Brimacombe score. Cuff pressure was maintained at 60 cm of H2O during the study. Secondary outcomes included the number of attempts for successful placement of PLMA, peak airway pressure, gastric tube placement, traumatic insertion, and complications were also compared. Parametric variables were analysed using unpaired t-test and categorical variables were analysed using Mann-Whitney and Chi-square test. Results In all, 200 patients were analysed. The mean oropharyngeal sealing pressure in Group P was 25.4 ± 3.5 cmH2O and 24.9 ± 3.8 cmH2O in Group W, (P = 0.34). There was no significant difference between the two groups in any of the secondary outcomes. There were no traumatic insertion or complications reported in both the groups. Conclusion Pinna-based size selection method can be used in PLMA placement in the paediatric population for positive pressure ventilation and it serves as an alternative method to weight-based selection.
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Affiliation(s)
- Ramya Ravi
- Department of Anesthesiology, Jawaharlal Institute of Post Graduate Medical Education and Research, Pondicherry, India
| | - V K Mohan
- Department of Anesthesiology, Jawaharlal Institute of Post Graduate Medical Education and Research, Pondicherry, India
| | - Ashok Shankar Badhe
- Department of Anesthesiology, Jawaharlal Institute of Post Graduate Medical Education and Research, Pondicherry, India
| | - Sandeep Kumar Mishra
- Department of Anesthesiology, Jawaharlal Institute of Post Graduate Medical Education and Research, Pondicherry, India
| | - Prasanna Udupi Bidkar
- Department of Anesthesiology, Jawaharlal Institute of Post Graduate Medical Education and Research, Pondicherry, India
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23
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Huang AS, Hajduk J, Rim C, Coffield S, Jagannathan N. Focused review on management of the difficult paediatric airway. Indian J Anaesth 2019; 63:428-436. [PMID: 31263293 PMCID: PMC6573050 DOI: 10.4103/ija.ija_250_19] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Management of the difficult paediatric airway management may be associated with a high rate of complications. It is important that clinicians understand the patient profiles associated with difficult airway management, and the equipment and techniques available to effectively manage these children. The goal of this focused review is to highlight key airway management concepts when managing the paediatric difficult airway. This includes understanding the advantages and limitations of various airway equipment designed for children and reviewing the difficult airway algorithm with its unique considerations for the paediatric patient. Early recognition of known risk factors and thorough preparation may be helpful in reducing the risk of complications during difficult airway management in children.
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Affiliation(s)
- Andrea S Huang
- Department of Pediatric Anesthesia, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - John Hajduk
- Department of Pediatric Anesthesia, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Catherine Rim
- Department of Pediatric Anesthesia, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Sarah Coffield
- Department of Pediatric Anesthesia, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Narasimhan Jagannathan
- Department of Pediatric Anesthesia, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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24
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Krishna SG, Syed F, Hakim M, Hakim M, Tumin D, Veneziano GC, Tobias JD. A comparison of supraglottic devices in pediatric patients. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2018; 11:361-365. [PMID: 30319293 PMCID: PMC6171511 DOI: 10.2147/mder.s177866] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background When managing patients with a difficult airway, supraglottic airways (SGAs) have been used as rescue devices or to serve as a conduit for endotracheal intubation. The current study compares various clinical outcomes, including the bronchoscopic view of the glottis when using 2 SGAs, the Air-Q® laryngeal mask airway (LMA) and the i-gel® SGA, in pediatric patients. Methods Patients ≤18 years of age were prospectively randomized to receive either the Air-Q® LMA or the i-gel® SGA. Following SGA placement, a flexible fiberoptic bronchoscope was inserted through the SGA to visualize the glottis. Time taken to obtain the bronchoscopic view and place the SGA, and the ability to seal the airway at 20 cmH2O were compared. The bronchoscopic view obtained was graded as follows: 1) glottic aperture seen completely; 2) glottic aperture seen partially with visual obstruction <50%; 3) glottic aperture seen, but visual obstruction >50%; and 4) glottic aperture not seen. Results Fifty patients were enrolled and 48 (22/26 male/female) were included in the analysis. Median age was 13 years (IQR: 7, 16) and median weight was 49 kg (IQR: 25, 70). The Air-Q® LMA and i-gel® SGA groups did not differ in device placement time (median of 19 vs 21 seconds; 95% CI of difference in medians: - 2 to 7; P=0.331), the time to achieve fiberoptic view of the glottis (median of 25 vs 21 seconds; 95% CI of difference: - 9 to 8; P=0.489) or the grade of the bronchoscopic view of the airway. Eight Air-Q® and 6 i-gel® supraglottic devices sealed the airway at 20 cmH2O. Discussion The time required for successful placement of the SGA, the time required for bronchoscopic view, and the quality of bronchoscopic view through the Air-Q® LMA and the i-gel® SGA did not differ.
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Affiliation(s)
- Senthil G Krishna
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA, .,Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USA,
| | - Faizaan Syed
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA,
| | - Mohammed Hakim
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA,
| | - Mumin Hakim
- Department of Surgery, Montefiore Medical Centre, Bronx, NY, USA
| | - Dmitry Tumin
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA,
| | - Giorgio C Veneziano
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA, .,Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USA,
| | - Joseph D Tobias
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA, .,Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USA,
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25
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Affiliation(s)
- T Asai
- Department of Anesthesiology, Dokkyo Medical University Koshigaya Hospital, 2-1-50 Minamikoshigaya, Koshigaya, Saitama 343-8555, Japan
| | - E P O'Sullivan
- Department of Anaesthesia, St James's Hospital, Dublin, Ireland
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26
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Best practice recommendations for difficult airway management in children—is it time for an update? Br J Anaesth 2018; 121:4-7. [DOI: 10.1016/j.bja.2018.04.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 04/18/2018] [Accepted: 04/20/2018] [Indexed: 11/22/2022] Open
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27
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Removal of a supraglottic airway in children with increased risk of respiratory complications: is timing of removal not important? Br J Anaesth 2018; 120:440-442. [DOI: 10.1016/j.bja.2017.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 12/01/2017] [Indexed: 11/19/2022] Open
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28
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Krishna SG, Bryant JF, Tobias JD. Management of the Difficult Airway in the Pediatric Patient. J Pediatr Intensive Care 2018; 7:115-125. [PMID: 31073483 DOI: 10.1055/s-0038-1624576] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 12/08/2017] [Indexed: 12/22/2022] Open
Abstract
Loss of airway control in children, if not resolved quickly, will lead to devastating consequences. Successful management of the pediatric difficult airway, both anticipated and unanticipated, is facilitated by preprocedure assessment and preparation. Accessibility of and continued hands-on training with modern airway instruments, familiarization with difficult airway guidelines, and collaboration with multidisciplinary airway teams can aid in the management of the difficult pediatric airway. This review outlines the importance of airway assessment and advanced airway equipment for children. It also discusses difficult airway management techniques and algorithms for the management and rescue of the pediatric difficult airway.
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Affiliation(s)
- Senthil G Krishna
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, United States.,Department of Anesthesiology and Pain Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Jason F Bryant
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, United States.,Department of Anesthesiology and Pain Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Joseph D Tobias
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, United States.,Department of Anesthesiology and Pain Medicine, The Ohio State University, Columbus, Ohio, United States.,Department of Pediatrics, The Ohio State University, Columbus, Ohio, United States
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Cronjé L. Bardet–Biedl syndrome: expect the unexpected, suspect the unsuspected. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2017. [DOI: 10.1080/22201181.2017.1379719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Larissa Cronjé
- Perioperative Research Group, Department of Anaesthesiology and Critical Care, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, King Edward VIII Hospital, Durban, South Africa
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30
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Videolaryngoscopy versus Fiber-optic Intubation through a Supraglottic Airway in Children with a Difficult Airway. Anesthesiology 2017. [DOI: 10.1097/aln.0000000000001758] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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31
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Affiliation(s)
- Jeong Rim Lee
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
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32
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Morimoto Y, Ohyamaguchi A, Inoue M, Yokoe C, Hanamoto H, Imaizumi U, Sugimura M, Niwa H. Airway management for glossopexy in infants with micrognathia and obstructive breathing. J Clin Anesth 2016; 36:127-132. [PMID: 28183550 DOI: 10.1016/j.jclinane.2016.10.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 08/11/2016] [Accepted: 10/27/2016] [Indexed: 11/30/2022]
Abstract
STUDY OBJECTIVES To identify airway management and tracheal intubation techniques for glossopexy in infants with preexisting airway obstruction under general anesthesia. DESIGN Retrospective, observational study. SETTINGS Operating room of a university hospital between January 2003 and March 2015. All operations were performed by oral and maxillofacial surgeons. PATIENTS Thirteen patients who received general anesthesia for glossopexy and reversal after 7 months. MEASUREMENTS The medical records of these infants were retrospectively examined to evaluate the following: age, sex, height and weight at surgery, preoperative airway status, tracheal intubation route (oral or nasal), method for inducing general anesthesia, method for establishing the airway during mask ventilation, apparatus used for tracheal intubation, Cormack-Lehane classification when using a Macintosh laryngoscope and video laryngoscope, and the need for airway placement after extubation. RESULTS Prone positioning and/or an airway of some kind before surgery were required in 38.5% of infants needing glossopexy. Difficult mask ventilation was common, occurring in 50% of the patients, and the incidence of airway placement during mask ventilation was significantly higher in infants with preoperative complete or incomplete obstruction (100%) than in infants with snoring (25%). Of these high-risk infants, 25% could not be intubated with a direct laryngoscope or Glidescope Cobalt and required fiberoptic intubation. CONCLUSION There are severe cases of infants with difficult mask ventilation and difficult tracheal intubation in which a fiberscope is required because video laryngoscopy fails to improve the view of the larynx.
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Affiliation(s)
- Yoshinari Morimoto
- Division of Anesthesiology, Department of Critical Care Medicine and Dentistry, Graduate School of Dentistry, Kanagawa Dental University, 82, Inaoka-cho, Yokosuka, Kanagawa 238-8580, Japan; Department of Dental Anesthesiology, Graduate School of Dentistry, Osaka University, 1-8, Yamadaoka, Suita, Osaka 565-0871, Japan.
| | - Aiko Ohyamaguchi
- Department of Dental Anesthesiology, Graduate School of Dentistry, Osaka University, 1-8, Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Mika Inoue
- Department of Dental Anesthesiology, Graduate School of Dentistry, Osaka University, 1-8, Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Chizuko Yokoe
- Division of Anesthesiology, Department of Critical Care Medicine and Dentistry, Graduate School of Dentistry, Kanagawa Dental University, 82, Inaoka-cho, Yokosuka, Kanagawa 238-8580, Japan
| | - Hiroshi Hanamoto
- Department of Dental Anesthesiology, Graduate School of Dentistry, Osaka University, 1-8, Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Uno Imaizumi
- Division of Anesthesiology, Department of Critical Care Medicine and Dentistry, Graduate School of Dentistry, Kanagawa Dental University, 82, Inaoka-cho, Yokosuka, Kanagawa 238-8580, Japan
| | - Mitsutaka Sugimura
- Department of Dental Anesthesiology, Graduate School of Dentistry, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima 890-8544, Japan
| | - Hitoshi Niwa
- Department of Dental Anesthesiology, Graduate School of Dentistry, Osaka University, 1-8, Yamadaoka, Suita, Osaka 565-0871, Japan
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[Interdisciplinary consensus statement on alternative airway management with supraglottic airway devices in pediatric emergency medicine: Laryngeal mask is state of the art]. Anaesthesist 2016; 65:57-66. [PMID: 26661389 DOI: 10.1007/s00101-015-0107-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Airway management with supraglottic airway devices (SGA) in life-threatening emergencies involving children is becoming increasingly more important. The laryngeal mask (LM) and the laryngeal tube (LT) are devices commonly used for this purpose. This article presents a literature review and consensus statement by various societies on the use of SGA in pediatric emergency medicine. MATERIAL AND METHODS Literature search in the database PubMed and classification of studies according to the criteria of the Oxford Centre for Evidence-based Medicine levels of evidence. RESULTS The evidence for successful application of the various types of LM is significantly higher than for LT application. Reports of smaller series of successful applications of LT are currently limited to selected research groups and centers. Insufficient evidence currently exists for the successful application of the LT especially for children below 10 kg body weight and, therefore, its routine use cannot currently be recommended. SGAs used for emergencies should have a possibility for gastric drainage. DISCUSSION Considering the scientific data and the large clinical experience with the LM in medical routine and emergency situations in children, currently only the LM can be recommended for alternative (i.e. non-intubation) airway management in children. If alternative airway management is part of a local emergency strategy, the LM should be provided in all pediatric sizes (1, 1.5, 2, 2.5, 3, 4 and 5) for prehospital and in-hospital emergency use and all users should be regularly trained in its application.
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Jagannathan N, Sohn L, Fiadjoe J. Paediatric difficult airway management: what every anaesthetist should know! Br J Anaesth 2016; 117 Suppl 1:i3-i5. [DOI: 10.1093/bja/aew054] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Templeton TW, Bryan YF. A two-stage approach to induction and intubation of two infants with Pierre Robin Sequence using a LMA Classic™ and Air-Q®: two cases report. Korean J Anesthesiol 2016; 69:390-4. [PMID: 27482318 PMCID: PMC4967636 DOI: 10.4097/kjae.2016.69.4.390] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 09/16/2015] [Accepted: 09/17/2015] [Indexed: 11/23/2022] Open
Abstract
The laryngeal mask airway (LMA) Classic™ and Air-Q® are supralaryngeal devices used for airway management in routine and difficult pediatric airways. We describe a novel two-stage technique of insertion of the LMA Classic™ awake prior to induction of anesthesia, to assure oxygenation and ventilation, and after induction removal and placement of the Air-Q® for intubation using the flexible fiberoptic bronchoscope. The LMA Classic's™ pliable design and relatively small size allow it to be easily placed in awake infants. In contrast, the Air-Q® is an excellent device for intubation because of its larger internal diameter and removable 9 mm adapter. Our goal was to reduce unpredictability and potentially increase the safety of induction of anesthesia and intubation in infants with Pierre Robin sequence. By using these devices in a two-stage approach we created a technique for consistent oxygenation, ventilation, and intubation in these infants.
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Affiliation(s)
- T Wesley Templeton
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Yvon F Bryan
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Jagannathan N, Shivazad A, Kolan M. Tracheal extubation in children with difficult airways: a descriptive cohort analysis. Paediatr Anaesth 2016; 26:372-7. [PMID: 26715011 DOI: 10.1111/pan.12837] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/27/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND Tracheal extubation in children with difficult airways may be associated with an increased risk of perioperative adverse events. AIMS The aim of this study was to describe the exubation techniques used/ success rates/ adverse events related to tracheal extubation practices in children with difficult airways. METHODS A retrospective analysis of tracheal extubation practices in the difficult airway population over a 78-month period was performed. Difficult airway was defined as a Cormack and Lehane Grade 3 view or greater, and/or tracheal intubation requiring ≥ 3 attempts, and/or the need for an alternate device to direct laryngoscopy for successful tracheal intubation, and/or difficult mask ventilation. Reasons for difficult airway, demographic/surgical data, technique(s) for tracheal extubation, success/failure of tracheal extubation, and adverse events were recorded. A failed tracheal extubation was defined as any adverse event related to the airway occurring within 6 h of extubation requiring reintubation. RESULTS A total of 519 patients were reported to have a difficult airway during this study period in a tertiary care pediatric center. Of these, 137 patients (26%) met inclusion criteria. Tracheal extubation was successfully performed in 130 patients (95%). The majority of tracheal exubations were performed without the use of additional airway adjuncts straight onto anesthesia face mask (121/137; 88%). Extubation failure occurred in seven cases (5%). Among the failed extubations, 6/7 children (85%) had evidence of severe upper airway obstruction and were <10 kg in weight. Of these children, one child required emergency tracheostomy, and two children (one with tracheal stenosis and other with spinal muscular atrophy) suffered from hypoxemic cardiac arrest and anoxic brain damage, respectively, and eventually died. CONCLUSIONS In the studied population of children with difficult airways handled in a tertiary center environment, the majority of tracheal extubations could be performed without the use of airway adjuncts. In a minority of patients, tracheal extubation was associated with severe adverse outcomes.
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Affiliation(s)
- Narasimhan Jagannathan
- Department of Pediatric Anesthesia, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Department of Anesthesiology, Northwestern University's Feinberg School of Medicine, Chicago, IL, USA
| | - Armin Shivazad
- Department of Pediatric Anesthesia, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Department of Anesthesiology, Northwestern University's Feinberg School of Medicine, Chicago, IL, USA
| | - Michael Kolan
- Department of Pediatric Anesthesia, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Department of Anesthesiology, Northwestern University's Feinberg School of Medicine, Chicago, IL, USA
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37
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Huang AS, Hajduk J, Jagannathan N. Advances in supraglottic airway devices for the management of difficult airways in children. Expert Rev Med Devices 2016; 13:157-69. [PMID: 26700886 DOI: 10.1586/17434440.2016.1136210] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
There are innumerable tools and devices available to facilitate airway management and life-saving gas exchange of the patient's lungs. Over the years, various designs and generations of supraglottic airway devices have proven to be effective in accomplishing this function. Their application has grown beyond the original purpose of controlling the normal pediatric airway without tracheal intubation, and has been incorporated in the difficult airway management algorithms of anesthesia societies around the world based on clear evidence of efficacy. Older supraglottic airway devices since the 1980's have been validated in multiple clinical trials to be safe and effective in the pediatric population, however there is also sufficient evidence that the newer designs have features that help overcome some limitations. These newer designs and features are effective in managing both the normal and difficult pediatric airway, and will be discussed in this comprehensive review.
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Affiliation(s)
- Andrea S Huang
- a Department of Pediatric Anesthesia , Ann and Robert H. Lurie Children's Hospital of Chicago , Chicago , IL , USA.,b Department of Anesthesiology , Northwestern University Feinberg School of Medicine , Chicago , IL , USA
| | - John Hajduk
- a Department of Pediatric Anesthesia , Ann and Robert H. Lurie Children's Hospital of Chicago , Chicago , IL , USA
| | - Narasimhan Jagannathan
- a Department of Pediatric Anesthesia , Ann and Robert H. Lurie Children's Hospital of Chicago , Chicago , IL , USA.,b Department of Anesthesiology , Northwestern University Feinberg School of Medicine , Chicago , IL , USA
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Abstract
Almost all supraglottic airways (SGAs) are now available in pediatric sizes. The availability of these smaller sizes, especially in the last five years has brought a marked change in the whole approach to airway management in children. SGAs are now used for laparoscopic surgeries, head and neck surgeries, remote anesthesia; and for ventilation during resuscitation. A large number of reports have described the use of SGAs in difficult airway situations, either as a primary or a rescue airway. Despite this expanded usage, there remains little evidence to support its usage in prolonged surgeries and in the intensive care unit. This article presents an overview of the current options available, suitability of one over the other and reviews the published data relating to each device. In this review, the author also addresses some of the general concerns regarding the use of SGAs and explores newer roles of their use in children.
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Affiliation(s)
- Rakhee Goyal
- Department of Anesthesia and Critical Care, Armed Forces Medical College, Pune, Maharashtra, India
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39
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Patel A, Clark SR, Schiffmiller M, Schoenberg C, Tewfik G. A survey of practice patterns in the use of laryngeal mask by pediatric anesthesiologists. Paediatr Anaesth 2015; 25:1127-31. [PMID: 26248211 DOI: 10.1111/pan.12727] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/11/2015] [Indexed: 01/30/2023]
Abstract
BACKGROUND Laryngeal mask is frequently the airway device of choice in routine general anesthesia for many procedures in children. Several studies have described the use of laryngeal masks in unconventional situations. This survey was undertaken to assess how laryngeal masks are being used by pediatric anesthesiologists. METHOD The 40-question electronic survey using SurveyMonkey™ was sent to 2740 members of the Society for Pediatric Anesthesia (SPA). This survey assessed the age, work environment, types of practice, and training levels, as well as clinical situations in which the practitioners use laryngeal masks across different pediatric age groups. RESULTS Seven hundred and forty-three (27.1%) responses were obtained. The use of laryngeal mask increased as the patient age increased in nearly every queried situation. The practitioners routinely utilize laryngeal masks in a variety of challenging scenarios, such as in patients with a recent upper respiratory infection, in the difficult airway, remote locations, and long-duration surgeries. A small percentage of pediatric anesthesiologists use laryngeal masks in laparoscopic surgery and prone position procedures. CONCLUSION Pediatric anesthesiologists are using laryngeal masks in both routine and challenging/unconventional situations. Although many of the uses for laryngeal masks are not explicitly stated in the manufacturer guidelines, literature and current practice support the use of laryngeal masks in several of these scenarios.
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Affiliation(s)
- Anuradha Patel
- Department of Anesthesiology, Rutgers - New Jersey Medical School, Newark, NJ, USA
| | - Scott R Clark
- Department of Anesthesiology, Rutgers - New Jersey Medical School, Newark, NJ, USA
| | - Moshe Schiffmiller
- Department of Anesthesiology, Rutgers - New Jersey Medical School, Newark, NJ, USA
| | - Catherine Schoenberg
- Department of Anesthesiology, Rutgers - New Jersey Medical School, Newark, NJ, USA
| | - George Tewfik
- Department of Anesthesiology, Saint Barnabas Health System, Livingston, NJ, USA
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40
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Managing the challenging pediatric airway: Continuing Professional Development. Can J Anaesth 2015; 62:1000-16. [DOI: 10.1007/s12630-015-0423-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 06/15/2015] [Indexed: 12/19/2022] Open
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Jagannathan N, Ramsey MA, White MC, Sohn L. An update on newer pediatric supraglottic airways with recommendations for clinical use. Paediatr Anaesth 2015; 25:334-45. [PMID: 25585975 DOI: 10.1111/pan.12614] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/10/2014] [Indexed: 11/26/2022]
Abstract
Supraglottic airways are an established part of routine and emergency pediatric airway management, including use in difficult airways and neonatal resuscitation. With the introduction of newer supraglottic airways in children, efficacy can only be determined by comparing these devices with those that are already well established (laryngeal mask airway Classic and laryngeal mask airway ProSeal). This narrative review aims to present the current literature on these newer supraglottic airways and give recommendations for their use in various clinical scenarios based on the existing evidence.
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Affiliation(s)
- Narasimhan Jagannathan
- Department of Pediatric Anesthesia, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University's Feinberg School of Medicine, Chicago, IL, USA
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Slinn SJ, Froom SR, Stacey MRW, Gildersleve CD. Are new supraglottic airway devices, tracheal tubes and airway viewing devices cost-effective? Paediatr Anaesth 2015; 25:20-6. [PMID: 25370686 DOI: 10.1111/pan.12564] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/03/2014] [Indexed: 11/28/2022]
Abstract
Over the past two decades, a plethora of new airway devices has become available to the pediatric anesthetist. While all have the laudable intention of improving patient care and some have proven clinical benefits, these devices are often costly and at times claims of an advantage over current equipment and techniques are marginal. Supraglottic airway devices are used in the majority of pediatric anesthetics delivered in the U.K., and airway-viewing devices provide an alternative for routine intubation as well as an option in the management of the difficult airway. Yet hidden beneath the convenience of the former and the technology of the latter, the impact on basic airway skills with a facemask and the lack of opportunities to fine-tune the core skill of intubation represent an unrecognised and unquantifiable cost. A judgement on this value must be factored into the absolute purchase cost and any potential benefits to the quality of patient care, thus blurring any judgement on cost-effectiveness that we might have. An overall value on cost-effectiveness though not in strict monetary terms can then be ascribed. In this review, we evaluate the role of these devices in the care of the pediatric patient and attempt to balance the advantages they offer against the cost they incur, both financial and environmental, and in any quality improvement they might offer in clinical care.
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Affiliation(s)
- Simon J Slinn
- Department of Anaesthetics and Intensive Care Medicine, University Hospital of Wales, Cardiff, UK
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A randomized comparison between the i-gel™ and the air-Q™ supraglottic airways when used by anesthesiology trainees as conduits for tracheal intubation in children. Can J Anaesth 2014; 62:587-94. [DOI: 10.1007/s12630-014-0304-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 12/15/2014] [Indexed: 10/24/2022] Open
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46
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Preemies to preschoolers: tubing tiny tots and trauma FAQs, part 3. J Emerg Nurs 2014; 40:505-8. [PMID: 24908451 DOI: 10.1016/j.jen.2014.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 02/24/2014] [Indexed: 11/22/2022]
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47
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Asai T. Is it safe to use supraglottic airway in children with difficult airways? Br J Anaesth 2014; 112:620-2. [DOI: 10.1093/bja/aeu005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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