1
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McLaughlin CS, Samant A, Saha AK, Lee LK, Gupta R, Templeton LB, Mathis MR, Vishneski S, Templeton TW. Bronchial Blocker Versus Endobronchial Intubation in Young Children Undergoing One-Lung Ventilation: A Multicenter Retrospective Cohort Study. Anesth Analg 2024:00000539-990000000-00939. [PMID: 39269648 DOI: 10.1213/ane.0000000000006973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2024]
Abstract
BACKGROUND Thoracic surgery and one-lung ventilation in young children carry significant risks. Approaches to one-lung ventilation in young children include endobronchial intubation (mainstem intubation) and use of a bronchial blocker. We hypothesized that endobronchial intubation is associated with a greater prevalence of airway complications compared to use of a bronchial blocker. METHODS The Multicenter Perioperative Outcomes Group database was queried from 2004 to 2022 for one-lung ventilation cases in children, 2 months to 3 years of age, inclusive. Airway notes and free-text comments were manually reviewed for airway complications. Documented airway complications were considered the primary outcome and were divided into "Moderate" and "Critical." Moderate airway complications were bronchial blocker or endotracheal tube movement leading to loss of isolation, hypoxemia requiring ventilatory intervention, bronchial blocker migration into the trachea, significant impairment of ventilation, and other. Critical complications included reintubation or airway replacement intraoperatively, complete endotracheal tube occlusion, cardiac arrest or airway-related bradycardia, and procedure aborted due to an airway issue. An adjusted propensity score-matched analysis was then used to assess the impact of a bronchial blocker on the outcomes of moderate and critical complications. RESULTS After exclusions, 704 patients were included in the primary analysis. In unadjusted analyses, no statistically significant difference was observed in moderate airway complications between endobronchial intubation and bronchial blocker cohorts: 37 of 444 (8.3%; 95% confidence interval [CI], 5.9%-11.3%) vs 28 of 260 (10.8%; 95% CI, 7.3%-15.2%) with P = .281. In the unadjusted analysis, the prevalence of critical airway complications was significantly higher in the endobronchial intubation cohort compared to the bronchial blocker cohort: 28 of 444 (6.3%; 95% CI, 4.2%-9.0%) vs 5 of 260 (1.9%; 95% CI, 0.6%-4.4%) with P = .008. In the propensity-matched cohort analysis, endobronchial intubation was associated with a slightly increased risk of critical complications compared to use of a bronchial blocker: 14 of 243 (5.8%; 95% CI, 2.8%-8.7%) vs 5 of 243 (2.1%; 95% CI, 0.3%-3.8%) with P = .035. CONCLUSIONS Endobronchial intubation might be associated with a slightly increased risk of critical airway complications compared to use of a bronchial blocker in young children undergoing thoracic surgery and one-lung ventilation. Further, prospective studies are needed before a definitive change in practice is recommended.
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Affiliation(s)
- Christopher S McLaughlin
- From the Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Anusha Samant
- From the Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Amit K Saha
- From the Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Lisa K Lee
- Department of Anesthesiology, Ronald Reagan UCLA Medical Center, Los Angeles, California
| | - Ruchika Gupta
- Department of Anesthesiology, University of Michigan Anesthesiology, Ann Arbor, Michigan
| | - Leah B Templeton
- From the Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Michael R Mathis
- Department of Anesthesiology, University of Michigan Anesthesiology, Ann Arbor, Michigan
| | - Susan Vishneski
- From the Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - T Wesley Templeton
- From the Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
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2
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Wadle M, Joffe D, Backer C, Ross F. Perioperative and Anesthetic Considerations in Vascular Rings and Slings. Semin Cardiothorac Vasc Anesth 2024; 28:152-164. [PMID: 38379198 DOI: 10.1177/10892532241234404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
Vascular rings represent an increasingly prevalent and diverse set of congenital malformations in which the aortic arch and its primary branches encircle and constrict the esophagus and trachea. Perioperative management varies significantly based on the type of lesion, its associated comorbidities, and the compromise of adjacent structures. Multiple review articles have been published describing the scope of vascular rings and relevant concerns from a surgical perspective. This review seeks to discuss the perioperative implications and recommendations of such pathology from the perspective of an anesthesia provider.
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Affiliation(s)
| | | | - Carl Backer
- Kentucky Children's Hospital Congenital Heart Clinic, Lexington, KY, USA
| | - Faith Ross
- Seattle Children's Hospital, Seattle, WA, USA
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3
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Vorias BJ, Barton NJ, McGlade DP, Alam N. Bronchial blockers: Has side-by-side fallen by the wayside? Not quite. Anaesth Intensive Care 2024; 52:137-139. [PMID: 38041615 DOI: 10.1177/0310057x231202812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2023]
Affiliation(s)
- Blake J Vorias
- Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital Melbourne, Fitzroy, Australia
| | - Nicholas J Barton
- Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital Melbourne, Fitzroy, Australia
| | - Desmond P McGlade
- Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital Melbourne, Fitzroy, Australia
| | - Naveed Alam
- Department of Cardiothoracic Surgery, St Vincent's Hospital Melbourne, Fitzroy, Australia
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4
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Nickel K, Schütz K, Carlens J, Grewendorf S, Wetzke M, Keil O, Dennhardt N, Rigterink V, Köditz H, Sasse M, Happle C, Beck CE, Schwerk N. Ten-year experience of whole lung lavage in pediatric Pulmonary Alveolar Proteinosis. KLINISCHE PADIATRIE 2024; 236:64-72. [PMID: 38262422 PMCID: PMC10883753 DOI: 10.1055/a-2194-3467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
BACKGROUND Pulmonary Alveolar Proteinosis (PAP) is extremely rare and can be caused by hereditary dysfunction of the granulocyte macrophage colony-stimulating factor receptor (GM-CSF) receptor, autoantibodies against GM-CSF, or other diseases leading to alveolar macrophage (AM) dysfunction. This leads to protein accumulation in the lung and severe dyspnea and hypoxemia. Whole lung lavage (WLL) is the first line treatment strategy. METHODS Here, we present data from more than ten years of WLL practice in pediatric PAP. WLL performed by the use of a single lumen or double lumen tube (SLT vs. DLT) were compared for technical features, procedure time, and adverse events. RESULTS A total of n=57 procedures in six PAP patients between 3.5 and 14.3 years of age were performed. SLT based WLL in smaller children was associated with comparable rates of adverse events but with longer intervention times and postprocedural intensive care treatment when compared to DLT based procedures. DISCUSSION Our data shows that WLL is feasible even in small children. DLT based WLL seems to be more effective, and our data supports the notion that it should be considered as early as possible in pediatric PAP. CONCLUSION WLL lavage is possible in small PAP patients but should performed in close interdisciplinary cooperation and with age appropriate protocols.
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Affiliation(s)
- Katja Nickel
- Clinic of Anesthesiology and Intensive Care Medicine, Hannover Medical
School, Hannover, Germany
| | - Katharina Schütz
- Department of Pediatric Pneumology, Allergology and Neonatology,
Hannover Medical School, Hannover, Germany
| | - Julia Carlens
- Department of Pediatric Pneumology, Allergology and Neonatology,
Hannover Medical School, Hannover, Germany
| | - Simon Grewendorf
- Department of Pediatric Pneumology, Allergology and Neonatology,
Hannover Medical School, Hannover, Germany
| | - Martin Wetzke
- Department of Pediatric Pneumology, Allergology and Neonatology,
Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease (BREATH),
Member of the German Center for Lung Research (DZL)
| | - Oliver Keil
- Clinic of Anesthesiology and Intensive Care Medicine, Hannover Medical
School, Hannover, Germany
| | - Nils Dennhardt
- Clinic of Anesthesiology and Intensive Care Medicine, Hannover Medical
School, Hannover, Germany
| | - Vanessa Rigterink
- Clinic of Anesthesiology and Intensive Care Medicine, Hannover Medical
School, Hannover, Germany
| | - Harald Köditz
- Department of Pediatric Cardiology and Intensive Medicine, Hannover
Medical School, Hannover, Germany
| | - Michael Sasse
- Department of Pediatric Cardiology and Intensive Medicine, Hannover
Medical School, Hannover, Germany
| | - Christine Happle
- Department of Pediatric Pneumology, Allergology and Neonatology,
Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease (BREATH),
Member of the German Center for Lung Research (DZL)
- RESIST Cluster of Excellence Infection Research, Hannover Medical
School, Hannover, Germany
| | - Christiane E. Beck
- Clinic of Anesthesiology and Intensive Care Medicine, Hannover Medical
School, Hannover, Germany
| | - Nicolaus Schwerk
- Department of Pediatric Pneumology, Allergology and Neonatology,
Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease (BREATH),
Member of the German Center for Lung Research (DZL)
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5
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Templeton TW, Krol B, Miller S, Lee LK, Mathis M, Vishneski SR, Chatterjee D, Gupta R, Shroeder RA, Saha AK. Hypoxemia in School-age Children Undergoing One-lung Ventilation: A Retrospective Cohort Study from the Multicenter Perioperative Outcomes Group. Anesthesiology 2024; 140:25-37. [PMID: 37738432 DOI: 10.1097/aln.0000000000004781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/24/2023]
Abstract
BACKGROUND Risk factors for hypoxemia in school-age children undergoing one-lung ventilation remain poorly understood. The hypothesis was that certain modifiable and nonmodifiable factors may be associated with increased risk of hypoxemia in school-age children undergoing one-lung ventilation and thoracic surgery. METHODS The Multicenter Perioperative Outcomes Group database was queried for children 4 to 17 yr of age undergoing one-lung ventilation. Patients undergoing vascular or cardiac procedures were excluded. The original cohort was divided into two cohorts: 4 to 9 and 10 to 17 yr of age inclusive. All records were reviewed electronically for the primary outcome of hypoxemia during one-lung ventilation, which was defined as an oxygen saturation measured by pulse oximetry (Spo2) less than 90% for 3 min or longer continuously, while severe hypoxemia was defined as Spo2 less than 90% for 5 min or longer. Potential modifiable and nonmodifiable risk factors associated with these outcomes were evaluated using separate multivariable least absolute shrinkage and selection operator regression analyses for each cohort. The covariates evaluated included age, extremes of weight, American Society of Anesthesiologists Physical Status of III or higher, duration of one-lung ventilation, preoperative Spo2 less than 98%, approach to one-lung ventilation, right operative side, video-assisted thoracoscopic surgery, lower tidal volume ventilation (defined as tidal volume of 6 ml/kg or less and positive end-expiratory pressure of 4 cm H2O or greater for more than 80% of the duration of one-lung ventilation), and procedure type. RESULTS The prevalence of hypoxemia in the 4- to 9-yr-old cohort and the 10- to 17-yr-old cohort was 24 of 228 (10.5% [95% CI, 6.5 to 14.5%]) and 76 of 1,012 (7.5% [95% CI, 5.9 to 9.1%]), respectively. The prevalence of severe hypoxemia in both cohorts was 14 of 228 (6.1% [95% CI, 3.0 to 9.3%]) and 47 of 1,012 (4.6% [95% CI, 3.3 to 5.8%]). Initial Spo2 less than 98% was associated with hypoxemia in the 4- to 9-yr-old cohort (odds ratio, 4.20 [95% CI, 1.61 to 6.29]). Initial Spo2 less than 98% (odds ratio, 2.76 [95% CI, 1.69 to 4.48]), extremes of weight (odds ratio, 2.18 [95% CI, 1.29 to 3.61]), and right-sided cases (odds ratio, 2.33 [95% CI, 1.41 to 3.92]) were associated with an increased risk of hypoxemia in the older cohort. Increasing age (1-yr increment; odds ratio, 0.88 [95% CI, 0.80 to 0.97]) was associated with a decreased risk of hypoxemia. CONCLUSIONS An initial room air oxygen saturation of less than 98% was associated with an increased risk of hypoxemia in all children 4 to 17 yr of age. Extremes of weight, right-sided cases, and decreasing age were associated with an increased risk of hypoxemia in children 10 to 17 yr of age. EDITOR’S PERSPECTIVE
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Affiliation(s)
- T Wesley Templeton
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Bridget Krol
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Scott Miller
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Lisa K Lee
- Department of Anesthesiology, UCLA, Los Angeles, California
| | - Michael Mathis
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Susan R Vishneski
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | | | - Ruchika Gupta
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | | | - Amit K Saha
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina
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6
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Öztürk L, Yiğit H. Preoperative preparation and postoperative care in children in thoracic surgery. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2024; 32:S1-S9. [PMID: 38584787 PMCID: PMC10995681 DOI: 10.5606/tgkdc.dergisi.2024.25708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 11/24/2023] [Indexed: 04/09/2024]
Abstract
Anesthesia for pediatric patients undergoing thoracic surgery continues to be distinctive due to differing anatomical and physiological characteristics compared to adults. Adequate preoperative preparation, appropriate tool selection for providing one-lung ventilation, perioperative pain management, and a multidisciplinary approach can ensure higher quality postoperative care. In this review, the perioperative anesthesia management for pediatric patients undergoing thoracic surgery will be discussed, starting from the preoperative preparation phase. Additionally, the issues related to the application and management of one-lung ventilation will also be assessed.
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Affiliation(s)
- Levent Öztürk
- Department of Anesthesiology and Reanimation, Bilkent City Hospital, Ankara, Türkiye
| | - Hülya Yiğit
- Department of Anesthesiology and Reanimation, Bilkent City Hospital, Ankara, Türkiye
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7
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Maddali MM, Al Wahaibi MMS, Patel MH, Zacharias S. Co-axial Endotracheal Tube Technique for Achieving One Lung Ventilation in a Toddler With a Space Occupying Malignant Tumor of the Right Lung. J Cardiothorac Vasc Anesth 2024; 38:243-247. [PMID: 37945408 DOI: 10.1053/j.jvca.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 09/28/2023] [Accepted: 10/04/2023] [Indexed: 11/12/2023]
Abstract
Achieving one-lung ventilation in pediatrics is often challenging. In caring for these patients, the anesthesiologist must consider the child's age and size, underlying tracheobronchial anatomy, equipment availability, urgency of procedure, and as well as the experience level of the anesthesiologist. This report describes a "tube-inside-tube" technique that was adopted for providing one-lung ventilation in a toddler. The method described here involved railroading a smaller endotracheal tube over a flexible intubation video endoscope into the left mainstem bronchus coaxially through a larger endotracheal tube placed in the trachea. The technique achieved effective left-lung ventilation and isolation of the operative right lung during surgical resection of a malignant mesenchymal tumor. On completion of the procedure, double-lung ventilation could be established through the endotracheal tube in the trachea after the retraction of the video endobronchial tube.
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Affiliation(s)
- Madan Mohan Maddali
- Department of Cardiac Anesthesia, National Heart Center, Royal Hospital, Muscat, Oman.
| | | | - Malay Hemantlal Patel
- Department of Cardiac Anesthesia, National Heart Center, Royal Hospital, Muscat, Oman
| | - Sunny Zacharias
- Department of Cardiothoracic Surgery, National Heart Center, Royal Hospital, Muscat, Oman
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8
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Jha L, Naaz S, Paul G, Kumar S. Curious Case of Pediatric One-Lung Ventilation with Two Endotracheal Tubes: A Case Report. Ann Card Anaesth 2024; 27:65-67. [PMID: 38722125 PMCID: PMC10876144 DOI: 10.4103/aca.aca_67_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/17/2023] [Accepted: 07/02/2023] [Indexed: 05/12/2024] Open
Abstract
ABSTRACT One-lung ventilation is indicated during thoracic surgery for visualization and exposure of surgical site. It is achieved with bronchial blockers, double-lumen endobronchial tube, single-lumen endotracheal tubes and Univent tube for infants and children. Fibreoptic bronchoscope is required for placing and confirming the correct position of these tubes. We report a perioperative management of safe conduct of one lung ventilation for a 6-year child undergoing left lower lobe lobectomy through C-MAC video laryngoscope guided two single lumen tubes in limited resource settings where paediatric-sized fibreoptic bronchoscope is unavailable.
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Affiliation(s)
- Lalit Jha
- Department of Anaesthesiology, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Shagufta Naaz
- Department of Anaesthesiology, All India Institute of Medical Sciences, Patna, Bihar, India
| | - George Paul
- Department of Anaesthesiology, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Sanjeev Kumar
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, Patna, Bihar, India
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9
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Patel N, Tripta K, Choudhary N, Jain V. An innovative technique for lung isolation in pediatric patient: Another arrow in the quiver! Paediatr Anaesth 2024; 34:94-95. [PMID: 37740708 DOI: 10.1111/pan.14769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/01/2023] [Accepted: 09/10/2023] [Indexed: 09/25/2023]
Affiliation(s)
- Nishant Patel
- Department of Anesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Kumari Tripta
- Department of Anesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Nitin Choudhary
- Department of Anesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Vishesh Jain
- Department of Pediatric Surgery, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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10
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Keil O, Avsar M, Beck C, Köditz H, Kübler J, Schwerk N, Zardo P, Sümpelmann R. [Case series report: Children undergoing complex surgery of tracheoesophageal fistula after ingestion of button batteries]. Laryngorhinootologie 2022. [PMID: 36170870 DOI: 10.1055/a-1887-8340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Oliver Keil
- Klinik für Anästhesiologie und Intensivmedizin_Medizinische Hochschule Hannover, Hannover
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11
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Semmelmann A, Loop T. [Anesthetic Management in Pediatric Thoracic Surgery]. Anasthesiol Intensivmed Notfallmed Schmerzther 2022; 57:550-562. [PMID: 36049739 DOI: 10.1055/a-1690-5620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Pediatric thoracic anesthesia is a challenging task. Specific implications arise from the patients' developmental stage, the disease and the intervention. An interdisciplinary management plan includes relevant factors. The main aspects are airway management, analgesic techniques and cardiorespiratory therapeutic strategies adapted to the underlying pathophysiology. Every step should be designed to provide optimal care. This article provides insight to specific airway, respiratory and regional anesthesia management in pediatric patients.
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12
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Gomes SH, Miranda A, Pêgo JM, Costa PS, Correia-Pinto J. Ultrasound-Guided Selective Bronchial Intubation: A Feasibility Study in Pediatric Animal Model. Front Med (Lausanne) 2022; 9:869771. [PMID: 35783614 PMCID: PMC9240755 DOI: 10.3389/fmed.2022.869771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 05/16/2022] [Indexed: 11/18/2022] Open
Abstract
Objective Selective one-lung ventilation used to optimize neonatal and pediatric surgical conditions is always a demanding task for anesthesiologists, especially during minimally invasive thoracoscopic surgery. This study aims to introduce an ultrasound-guided bronchial intubation and exclusion technique in a pediatric animal model. Methods Seven rabbits were anesthetized and airway ultrasound acquisitions were done. Results Tracheal tube progression along the trachea to the right bronchus and positioning of the bronchial blocker in the left bronchus were successfully done with consistent ultrasound identification of relevant anatomical structures. Conclusion The study provided a new application of ultrasound in airway management. More advanced experimental studies are needed since this technique has the potential for translation to pediatric anesthesia.
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Affiliation(s)
- Sara Hora Gomes
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B’s-PT Government Associate Laboratory, Braga, Portugal
- *Correspondence: Sara Hora Gomes,
| | - Alice Miranda
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B’s-PT Government Associate Laboratory, Braga, Portugal
| | - José Miguel Pêgo
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B’s-PT Government Associate Laboratory, Braga, Portugal
| | - Patrício S. Costa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B’s-PT Government Associate Laboratory, Braga, Portugal
| | - Jorge Correia-Pinto
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B’s-PT Government Associate Laboratory, Braga, Portugal
- Department of Pediatric Surgery, Hospital de Braga, Braga, Portugal
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13
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Mohammad Shehata I, Elhassan A, Zaman B, Viswanath O. Challenge of Lung Isolation in Patients with Vocal Cord Implants. Anesth Pain Med 2022; 12:e123370. [PMID: 35433377 PMCID: PMC8995872 DOI: 10.5812/aapm.123370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 02/20/2022] [Indexed: 12/05/2022] Open
Abstract
Glottic closure insufficiency increases the risk of aspiration and pneumonia, particularly in the elderly. Medialization thyroplasty is an open surgical procedure for treating glottic incompetency by approximating both vocal folds. The vocal fold medialization is achieved by inserting an implant to bring the nonmobile fold to the unaffected side. Lung isolation in patients with vocal cord implantation poses a unique challenge. Understanding the risks of different modalities of lung isolation and their impacts on the vocal cord implant is crucial to implementing a specifically tailored plan. Preoperative bronchoscopy, intraoperative video laryngoscopy, and bronchoscopy are ideal methods for assessing the vocal fold implants and guiding the lung isolation technique. Bronchial blocker through a single-lumen endotracheal tube may be the preferred choice to avoid the injury of the stretched vocal cords and dislodgement of the implant by a larger diameter double-lumen tube.
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Affiliation(s)
- Islam Mohammad Shehata
- Department of Anesthesiology, Ain Sham University, Cairo, Egypt
- Corresponding Author: Department of Anesthesiology, Ain Sham University, Cairo, Egypt.
| | - Amir Elhassan
- Community Memorial Hospital Center, Ventura, California, USA
| | - Behrooz Zaman
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
- Corresponding Author: Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran.
| | - Omar Viswanath
- Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, Los Angeles, USA
- Valley Anesthesiology and Pain Consultants, Envision Physician Services, Phoenix, Arizona, USA
- Department of Anesthesiology, University of Arizona College of Medicine, Phoenix, Arizona, USA
- Department of Anesthesiology, Creighton University School of Medicine, Omaha, Nebraska, USA
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14
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Fallberichte: Kinder mit tracheoösophagealer Fistel nach Knopfbatterieningestion. Anasthesiol Intensivmed Notfallmed Schmerzther 2022; 57:142-149. [DOI: 10.1055/a-1505-0674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
ZusammenfassungFremdkörperingestionen bei Kindern nehmen stetig zu – dabei werden u. a. Knopfbatterien sehr häufig verschluckt. Das weitverbreitete Modell CR2032 führt bereits nach kurzer Zeit zu schweren
Laugenverätzungen mit möglicher Perforation in benachbarte Organe. Dieser Fallserienbericht stellt 4 Kinder vor, die nach Ingestion von Knopfbatterien eine tracheoösophageale Fistel
entwickelten und in unserer Kinderklinik interdisziplinär versorgt wurden.
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15
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Lazar A, Chatterjee D, Templeton TW. Error traps in pediatric one-lung ventilation. Paediatr Anaesth 2022; 32:346-353. [PMID: 34767676 DOI: 10.1111/pan.14333] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/31/2021] [Accepted: 11/03/2021] [Indexed: 01/11/2023]
Abstract
With the advent of thoracoscopic surgery, the benefits of lung isolation in children have been increasingly recognized. However, because of the small airway dimensions, equipment limitations in size and maneuverability, and limited respiratory reserve, one-lung ventilation in children remains challenging. This article highlights some of the most common error traps in the management of pediatric lung isolation and focuses on practical solutions for their management. The error traps discussed are as follows: (1) the failure to take into consideration relevant aspects of tracheobronchial anatomy when selecting the size of the lung isolation device, (2) failure to execute correct placement of the device chosen for lung isolation, (3) failure to maintain lung isolation related to surgical manipulation and isolation device movement, (4) failure to select appropriate ventilator strategies during one-lung ventilation, and (5) failure to appropriately manage and treat hypoxemia in the setting of one-lung ventilation.
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Affiliation(s)
- Alina Lazar
- Department of Pediatric Anesthesia, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Debnath Chatterjee
- Department of Anesthesiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
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16
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Challenges Faced During the Ventilation of a Child With Bronchobiliary Fistula: A Case Report. A A Pract 2021; 14:e01281. [PMID: 32909720 DOI: 10.1213/xaa.0000000000001281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Hepatoblastoma is the most frequently occurring malignant tumor of the liver in children (ages ≤5 years). The formation of bronchobiliary fistula is a rare complication. We present a case report that describes the associated anesthetic challenges that we encountered for the treatment of this pathology.
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17
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Goetschi M, Kemper M, Kleine-Brueggeney M, Dave MH, Weiss M. Inflation volume-balloon diameter and inflation pressure-balloon diameter characteristics of commonly used bronchial blocker balloons for single-lung ventilation in children. Paediatr Anaesth 2021; 31:474-481. [PMID: 33406307 DOI: 10.1111/pan.14123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/28/2020] [Accepted: 12/29/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Balloon-tipped bronchial blocker catheters are widely used in pediatric thoracic anesthesia to establish single-lung ventilation. In clinical practice, their balloons demonstrate sudden expansion when inflated with air. In addition, there are concerns related to the high inflation pressures required to expand the balloons. METHODS This in vitro study assessed inflation volume- and inflation pressure-balloon diameter characteristics of the Fogarty arterial embolectomy catheters and Arndt endobronchial blockers. Balloon diameters were photographically assessed during unrestricted volume- and pressure-guided inflation, using air up to the maximum allowed inflation volume as indicated by the manufacturers. Inflation pressures required to open the blocker balloons and inflation pressures needed to expand them to maximum indicated diameter were measured. RESULTS Volume-guided inflation demonstrated a late acute rise in diameter in Fogarty blocker balloons, whereas in the Arndt endobronchial blocker balloons almost linear inflation volume-to-diameter characteristics were observed. Pressure-guided inflation on the other hand demonstrated low-volume, high-pressure characteristics in the Fogarty blocker balloons, with inflation pressures required to expand the balloons to maximum diameters ranging from (mean (SD)) 636 (75) to 947 (152) cmH2 O. The inflation pressures required to open the Fogarty blocker balloons were even >1000 cmH2 O. Inflation pressures required to expand the 5 F, 7 F, and 9 F Arndt endobronchial blocker balloons to maximum indicated diameter were much lower, namely at 218 (15), 252 (28), and 163 (8) cmH2 O. CONCLUSION Based on these study findings, the balloons of Fogarty arterial embolectomy catheters represent high-pressure devices and do not permit stepwise controlled bronchial blockage. The Arndt endobronchial blockers have some advantages over the Fogarty blocker devices, but also represent high-pressure equipment and must be used with caution and limited duration. Manufacturers are asked to design pediatric endobronchial blocker catheters with truly high-volume, low-pressure balloons in accordance to age-related pediatric airway dimensions.
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Affiliation(s)
- Markus Goetschi
- Department of Anesthesia, University Children's Hospital Zurich, Zurich, Switzerland
| | - Michael Kemper
- Department of Anesthesia, University Children's Hospital Zurich, Zurich, Switzerland.,Department of Anesthesiology, RWTH Aachen University Hospital, Aachen, Germany
| | | | - Mital H Dave
- Department of Anesthesia, University Children's Hospital Zurich, Zurich, Switzerland
| | - Markus Weiss
- Department of Anesthesia, University Children's Hospital Zurich, Zurich, Switzerland
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18
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Choudhry DK, Brenn BR, DiSilvio GM. Endobronchial Blocker Placement for Lung Isolation in Children: A Simple Head Turn Technique. A A Pract 2021; 15:e01390. [PMID: 33577172 DOI: 10.1213/xaa.0000000000001390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Endobronchial blockers are frequently used for lung isolation in children <8 years of age. The aim of our report is to highlight the problem that we have encountered with the wire-guided endobronchial blocker (WEB), where the wire loop used to couple the blocker and the fiberoptic scope (FOS) may straddle the carina. We describe the "uncoupled head turn technique" that we have adopted to avoid this problem. If the coupled technique is deemed necessary, a method to keep the wire loop snug around the FOS is described to avoid the straddling problem.
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Affiliation(s)
- Dinesh K Choudhry
- From the Department of Anesthesiology, Shriners Hospital for Children, Philadelphia, Pennsylvania
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19
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Moser B, Kemper M, Dullenkopf A, Dave MH, Buehler PK, Weiss M. Simulated dimensional compatibility of uncuffed and cuffed tracheal tubes for selective endobronchial intubation in children. Paediatr Anaesth 2021; 31:167-177. [PMID: 33128267 DOI: 10.1111/pan.14058] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/30/2020] [Accepted: 10/23/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cuffed tracheal tubes have recently been recommended for selective endobronchial intubation to establish single-lung ventilation even in smaller children. This implies that, compared with uncuffed tracheal tubes, the cuffed tracheal tubes selected will be smaller and therefore have a shorter length. We hypothesized that cuffed tracheal tubes might be of insufficient length for selective endobronchial intubation if the tube cuff were fully immersed in the left or right mainstem bronchus. METHODS The distance from the proximal end of the tracheal tube to the upper border of the cuff in cuffed tracheal tubes and to the upper margin of the Murphy eye in uncuffed tracheal tubes, respectively, was assessed in sizes 3.0-7.0 mm internal diameter. The raw data sets of two previously performed studies obtained from 337 children aged from birth to 16 years, including the distances "teeth to tracheal tube tip" and "tracheal tube tip to carina," were used to calculate age-, weight-, and height-related data for the distance from "teeth to carina." Tracheal tube dimensions were compared with age-related distances from "teeth to carina," applying published recommendations for the selection of uncuffed and cuffed tracheal tubes for selective endobronchial intubation in children. RESULTS The differences between the length of the age-related tracheal tube and the tracheal tube insertion length required to guarantee full insertion of the tracheal tube cuff or the Murphy eye within the mainstem bronchus ranged from -3.5 to 52.6 mm in cuffed tracheal tubes and from 42.3 to 83.3 mm in uncuffed tracheal tubes. CONCLUSIONS For many age groups of patients requiring selective endobronchial intubation, the lengths of cuffed tracheal tubes, in contrast to those of uncuffed tracheal tubes, were revealed to be critically short for safe taping outside the oral cavity with the cuff placed completely within the right or left mainstem bronchus.
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Affiliation(s)
- Berthold Moser
- Department of Anaesthesia, University Children's Hospital Zurich, Zurich, Switzerland.,Department of Anaesthesia and Intensive Care, Spital Limmattal, Schlieren, Switzerland
| | - Michael Kemper
- Department of Anaesthesia, University Children's Hospital Zurich, Zurich, Switzerland
| | - Alexander Dullenkopf
- Department of Anaesthesia and Intensive Care, Kantonsspital, Frauenfeld, Switzerland
| | - Mital H Dave
- Department of Anaesthesia, University Children's Hospital Zurich, Zurich, Switzerland
| | - Philipp K Buehler
- Department of Anaesthesia, University Children's Hospital Zurich, Zurich, Switzerland
| | - Markus Weiss
- Department of Anaesthesia, University Children's Hospital Zurich, Zurich, Switzerland
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20
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Kiran M, Babu S, Dash PK, Shankar S, Pr S. Emergency Lung Isolation in a Child With Massive Pulmonary Hemorrhage in a Remote Location: Is a Cardiac Catheterization Suite a Boon or Bane? J Cardiothorac Vasc Anesth 2020; 35:3030-3034. [PMID: 33109486 DOI: 10.1053/j.jvca.2020.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 10/04/2020] [Accepted: 10/07/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Molli Kiran
- Department of Anesthesia and Critical Care, Andhra Medical College, Visakhapatnam, Andhra Pradesh, India
| | - Saravana Babu
- Division of Cardiothoracic and Vascular Anesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India.
| | - Prasanta Kumar Dash
- Division of Cardiothoracic and Vascular Anesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Sruthi Shankar
- Division of Cardiothoracic and Vascular Anesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Suneel Pr
- Division of Cardiothoracic and Vascular Anesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
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21
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Au V, Marsh B, Benkwitz C. Resection of a Posterior Mediastinal Mass in a 4-Year-Old Child Complicated by Difficult Airway Management and Emergent Use of Extracorporeal Membrane Oxygenation. Semin Cardiothorac Vasc Anesth 2020; 24:349-354. [PMID: 32998636 DOI: 10.1177/1089253220960267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Literature on posterior mediastinal masses is limited. Furthermore, they have traditionally been described to pose lower cardiopulmonary risks compared with anterior mediastinal masses. Studies on posterior mediastinal masses are even more limited in the pediatric population. We present a case of a large posterior mediastinal mass in a 4-year-old child who presented with extremely difficult airway management during endobronchial intubation due to severe external compression that led to use of an adapted airway management technique with a rigid airway exchanger for lung isolation. Due to the pathology of the mass, a tracheal tear was encountered during surgical dissection and the patient required emergent venovenous extracorporeal membrane oxygenation to allow for successful airway repair and complete resection of the mass.
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Affiliation(s)
- Valerie Au
- University of California San Francisco, CA, USA
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22
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Koo BS, Lee SH, Lee SJ, Jung WH, Chung YH, Lee JH, Cho SH, Kim SH. A case of one-lung ventilation using a single-lumen tube placed under fiberoptic bronchoscopic guidance in a 4-year-old child: A case report. Medicine (Baltimore) 2020; 99:e21737. [PMID: 32846795 PMCID: PMC7447431 DOI: 10.1097/md.0000000000021737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE One-lung ventilation (OLV) is essential for adequate visualization and exposure of the surgical site via a videoscopic approach. Although many instruments facilitating OLV are available, the choice is limited in pediatric patients. PATIENT CONCERNS A 4-year-old female (weight: 18.6 kg, height: 100 cm) was admitted via our pediatric outpatient clinic because of recurrent hemoptysis, 2 weeks in duration. She had no medical or surgical history. DIAGNOSIS Contrast-enhanced computed tomography (CT) revealed a 4.5-cm-diameter mass in the left, lower lung lobe. She was diagnosed with a congenital pulmonary airway malformation (CPAM). INTERVENTIONS She was scheduled for emergency lobectomy via video-assisted thoracoscopic surgery (VATS). To ensure successful VATS, OLV was essential. As our hospital lacked a small-diameter fiberoptic bronchoscope and a proper bronchial blocker, we decided to use single-lumen tube (SLT) with adult fiberoptic bronchoscope. OUTCOMES We performed successful bronchoscopic-guided OLV using a SLT. We aligned the tube to the right upper lobar bronchus and Murphy eye to prevent obstruction of the right upper lobe bronchus. At the end of surgery, the endotracheal tube lumen had been narrowed by blood clots, we decided to exchange the tracheal tube. The tube was immediately exchanged. After re-intubation, the pulse oximetry (SpO2) then gradually increased. LESSONS Appropriate preparation and careful management should be considered to perform OLV in pediatric patients without significant complications.
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Maddali MM, Zacharias S, Kandachar PS, Annamalai A, Abolwafa A, Ananthasubramanian R, Nguyen K, Diaz-Castrillon CE, Viegas M. Bronchial Disruption Repair in a Child: Suggestions for Opting for One-Lung Ventilation or Extracorporeal Circulatory Support. J Cardiothorac Vasc Anesth 2020; 34:3146-3153. [PMID: 32684429 DOI: 10.1053/j.jvca.2020.06.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 06/13/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Madan Mohan Maddali
- Department of Cardiac Anesthesia, National Heart Center, Royal Hospital, Muscat, Sultanate of Oman.
| | - Sunny Zacharias
- Department of Cardiothoracic Surgery, National Heart Center, Royal Hospital, Muscat, Sultanate of Oman
| | | | - Anbarasu Annamalai
- Department of Cardiac Anesthesia, National Heart Center, Royal Hospital, Muscat, Sultanate of Oman
| | - Amr Abolwafa
- Department of Cardiothoracic Surgery, National Heart Center, Royal Hospital, Muscat, Sultanate of Oman
| | | | - Khoa Nguyen
- Department of Anesthesiology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | | | - Melita Viegas
- Department of Pediatric Cardiac Surgery, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
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24
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The use of three-dimensional printing and virtual reality to develop a personalised airway plan in a 7.5-year-old child. Eur J Anaesthesiol 2020; 37:512-515. [DOI: 10.1097/eja.0000000000001184] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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25
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Forman N, Sinskey J, Shalabi A. A Review of Middle Aortic Syndromes in Pediatric Patients. J Cardiothorac Vasc Anesth 2020; 34:1042-1050. [DOI: 10.1053/j.jvca.2019.07.130] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 07/09/2019] [Accepted: 07/12/2019] [Indexed: 01/04/2023]
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Abstract
Perioperative risk of morbidity and mortality for neonates is significantly higher than that for older children and adults. At particular risk are neonates born prematurely, neonates with major or severe congenital heart disease, and neonates with pulmonary hypertension. Presently no consensus exists regarding the safest anesthetic regimen for neonates. Regional anesthesia appears to be safe, but does not reduce the overall risk of postoperative apnea. Former preterm infants require postoperative observation for apnea. The anesthesiologist caring for the neonate for major surgery should be knowledgeable of the unique physiology of the neonate and maintain the highest level of vigilance throughout.
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Affiliation(s)
- Calvin C Kuan
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, 300 Pasteur Drive, H3582, Stanford, CA 94305, USA.
| | - Susanna J Shaw
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, 300 Pasteur Drive, H3582, Stanford, CA 94305, USA
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Wu C, Liang X, Liu B. Selective pulmonary lobe isolation with Arndt pediatric endobronchial blocker for an infant: A case report. Medicine (Baltimore) 2019; 98:e18262. [PMID: 31852095 PMCID: PMC6922580 DOI: 10.1097/md.0000000000018262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Attaining lung isolation in the infant is a challenge for anesthesia care providers. Pulmonary lobe isolation is more challenging. We describe an approach to performing selective pulmonary lobe isolation using the pediatric endobronchial blocker in an infant in the absence of appropriate auxiliary guidance tool. PATIENT CONCERNS An 8-month-old and 9.5 kg male infant was admitted because of repeated cough with fever for 3 months and a large cyst of his right lung for 2 weeks. He had been living in a pastoral area with his parents. DIAGNOSIS Based on the chest computed tomography (CT) and his history about long-term residence in the pastoral area, this patient's diagnosis was considered as right middle lobe hydatid cyst. INTERVENTIONS Guided by a fiberoptic bronchoscope, a cuffed 4.0-mm inside diameter (ID) endotracheal tube was successfully placed into the right main bronchus of this infant. Then, pediatric 5-French (Fr) endobronchial blocker was placed into the right middle and lower lobes through the endotracheal tube without navigation of fiberoptic bronchoscope. OUTCOMES Lobe isolation was successfully achieved for right middle lobectomy. This approach allows clinicians to perform lobe isolation in the absence of fiberoptic bronchoscope with very small outer diameter. CONCLUSION This technique is relatively easy to use and less dependent on equipment with small outer diameter in the selective pulmonary lobe isolation in infants and small children.
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Fuertes Saez N, Escriba Alepuz F, Argente Navarro P. Selective bronchial block with Uniblocker ™ in paediatric pulmonary sequestration. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2019. [DOI: 10.1016/j.tacc.2019.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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29
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Chen GY, Yeh MS. Modified use of Fogarty catheter for unanticipated difficult airway in children. J Clin Anesth 2018; 55:15-16. [PMID: 30586659 DOI: 10.1016/j.jclinane.2018.12.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 11/15/2018] [Accepted: 12/18/2018] [Indexed: 11/17/2022]
Affiliation(s)
- Guan-Yu Chen
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Taiwan
| | - Ming-Sung Yeh
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Taiwan.
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Semmelmann A, Kaltofen H, Loop T. Reply to Ho, Anthony; Mizubuti, Glenio; Dion, Joanna, regarding their comments "Comments on 'Anesthesia of thoracic surgery in children'". Paediatr Anaesth 2018; 28:679-680. [PMID: 30133909 DOI: 10.1111/pan.13426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Axel Semmelmann
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center, Freiburg, Germany
| | - Heike Kaltofen
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center, Freiburg, Germany
| | - Torsten Loop
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center, Freiburg, Germany
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31
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Semmelmann A, Kaltofen H, Loop T. Anesthesia of thoracic surgery in children. Paediatr Anaesth 2018; 28:326-331. [PMID: 29484775 DOI: 10.1111/pan.13350] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/27/2018] [Indexed: 02/06/2023]
Abstract
Providing anesthesia in children with thoracic disease is a challenging task. The effects of the underlying disease, the surgical interventions, and preexisting condition of the patient need to be considered when planning perioperative care. The perioperative care for children undergoing thoracic surgery requires specific techniques adapted to the pediatric physiology and anatomy. This review is focused on anesthetic strategies for thoracic surgery with an emphasis on perioperative analgesia including neuraxial techniques.
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Affiliation(s)
- Axel Semmelmann
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center, Freiburg, Germany
| | - Heike Kaltofen
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center, Freiburg, Germany
| | - Torsten Loop
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center, Freiburg, Germany
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