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Sethi P, Narayanan B, Dang D, Kumari K. Airway management in a pediatric patient with glottic web: An anesthetic challenge in non-operating room anesthesia. J Anaesthesiol Clin Pharmacol 2024; 40:363-364. [PMID: 38919416 PMCID: PMC11196063 DOI: 10.4103/joacp.joacp_411_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 04/01/2023] [Accepted: 04/02/2023] [Indexed: 06/27/2024] Open
Affiliation(s)
- Priyanka Sethi
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Balakrishnan Narayanan
- Department of Anaesthesiology and Critical Care, Madras Medical Mission Hospital, Chennai, Tamil Nadu, India
| | - Deepanshu Dang
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Kamlesh Kumari
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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2
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Schwake I, Sprinz M, Scaal M, Eifinger F. Anatomical investigations on the upper airway in premature and newborn babies. Clin Anat 2023; 36:42-49. [PMID: 36177789 DOI: 10.1002/ca.23955] [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: 05/30/2022] [Revised: 08/22/2022] [Accepted: 09/21/2022] [Indexed: 12/14/2022]
Abstract
Safe intubation of newborns remains a challenge. This investigates the upper airway anatomy of (pre-)term infants was investigated to improve airway management and the development of airway devices. Angles and diameters of both oral and nasal intubation pathways of 22 cadavers of premature and term stillborn infants were measured, relative to their gestational age (GA) and tested for statistical significance. The systematic influence of sex on the distribution of values was examined. Cast models of the oral and nasal intubation pathway were (produced using a silicone dental impression material) 3D-scanned. No significant correlation with GA was seen in the angles studied. However, four distances around the hard and soft palate did show statistically significant positive correlations with GA. Regarding differences between the sexes, only the angle between the entrance of the trachea and the esophagus was greater for male cadavers. The angles of the ventilation pathway of (pre-)term infants do not depend systematically on GA. Anatomically, laryngeal masks might therefore also be well-suited ventilators for preterm infants. Alterations in the size but not the shape of laryngeal masks for small preterm infants is recommended. The data obtained may thus be used as a basis for the development of airway devices and airway simulators for medical education and clinical training.
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Affiliation(s)
- Ida Schwake
- Department of Pediatric Critical Care Medicine and Neonatology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Maria Sprinz
- Department of Pediatric Critical Care Medicine and Neonatology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Martin Scaal
- Department of Anatomy, Institute of Anatomy II, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Frank Eifinger
- Department of Pediatric Critical Care Medicine and Neonatology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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3
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Effectiveness of Indirect and Direct Laryngoscopes in Pediatric Patients: A Systematic Review and Network Meta-Analysis. CHILDREN 2022; 9:children9091280. [PMID: 36138589 PMCID: PMC9497385 DOI: 10.3390/children9091280] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/20/2022] [Accepted: 08/21/2022] [Indexed: 11/17/2022]
Abstract
This research aimed to produce a coherent ranking of the effectiveness of intubation devices in pediatric patients using network meta-analysis (NMA). We searched the electric databases for prospective randomized studies that compared different tracheal intubation devices in pediatric patients. The primary outcome was intubation failure at the first attempt. Secondary outcomes were glottic visualization and intubation time. The statistical analysis performed used DerSimonian and Laird random-effects models. Frequentist network meta-analysis was conducted, and network plots and network league tables were produced. Subgroup analysis was performed after excluding rigid-fiberscope-type indirect laryngoscopes. Thirty-four trials comparing 13 devices were included. Most laryngoscopes had the same intubation failure rate as the Macintosh reference device. Only the Truview PCD™ had a significantly higher intubation failure rate than the Macintosh (odds ratio 4.78, 95% confidence interval 1.11–20.6) The highest-ranking laryngoscope was the Airtaq™ (P score, 0.90), and the AirwayScope™, McGrath™, and Truview EVO2™ ranked higher than the Macintosh. The Bullard™ had the lowest ranking (P score, 0.08). All laryngoscopes had the same level of glottic visualization as the Macintosh and only the C-MAC™ had a significantly shorter intubation time. Intubation time was significantly longer when using the GlideScope™, Storz DCI™, Truview PCD™, or Bullard™ compared with the Macintosh. P score and ranking of devices in the subgroup analyses were similar to those in the main analysis. We applied NMA to create a consistent ranking of the effectiveness of intubation devices in pediatric patients. The findings of NMA suggest that there is presently no laryngoscope superior to the Macintosh laryngoscope in terms of tracheal intubation failure rate and glottic visualization in pediatric patients.
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4
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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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5
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Dalesio NM, Burgunder L, Diaz-Rodriguez NM, Jones SI, Duval-Arnould J, Lester LC, Tunkel DE, Kudchadkar SR. Factors Associated With Pediatric Emergency Airway Management by the Difficult Airway Response Team. Cureus 2021; 13:e16118. [PMID: 34367755 PMCID: PMC8330490 DOI: 10.7759/cureus.16118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2021] [Indexed: 11/05/2022] Open
Abstract
Background The goal of this study was to determine if difficult airway risk factors were similar in children cared for by the difficult airway response team (DART) and those cared for by the rapid response team (RRT). Methods In this retrospective database analysis of prospectively collected data, we analyzed patient demographics, comorbidities, history of difficult intubation, and intubation event details, including time and place of the emergency and devices used to successfully secure the airway. Results Within the 110-patient cohort, median age (IQR) was higher among DART patients than among RRT patients [8.5 years (0.9-14.6) versus 0.3 years (0.04-3.6); P < 0.001]. The odds of DART management were higher for children ages 1-2 years (aOR, 43.3; 95% CI: 2.73-684.3) and >5 years (aOR, 13.1; 95% CI: 1.85-93.4) than for those less than one-year-old. DART patients were more likely to have craniofacial abnormalities (aOR, 51.6; 95% CI: 2.50-1065.1), airway swelling (aOR, 240.1; 95% CI: 13.6-4237.2), or trauma (all DART managed). Among patients intubated by the DART, children with a history of difficult airway were more likely to have musculoskeletal (P = 0.04) and craniofacial abnormalities (P < 0.001), whereas children without a known history of difficult airway were more likely to have airway swelling (P = 0.04). Conclusion Specific clinical risk factors predict the need for emergency airway management by the DART in the pediatric hospital setting. The coordinated use of a DART to respond to difficult airway emergencies may limit attempts at endotracheal tube placement and mitigate morbidity.
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Affiliation(s)
- Nicholas M Dalesio
- Otolaryngology/Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, USA.,Anesthesiology and Critical Care, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Lauren Burgunder
- Pediatrics, Johns Hopkins University School of Medicine, Baltimore, USA
| | | | - Sara I Jones
- Anesthesiology and Critical Care, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Jordan Duval-Arnould
- Johns Hopkins Medicine Simulation Center, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Laeben C Lester
- Anesthesiology and Critical Care, Johns Hopkins University School of Medicine, Baltimore, USA
| | - David E Tunkel
- Otolaryngology/Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Sapna R Kudchadkar
- Anesthesiology and Critical Care, Johns Hopkins University School of Medicine, Baltimore, USA
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6
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Lejus-Bourdeau C, Pousset F, Magne C, Bazin O, Grillot N, Pichenot V. Low-cost versus high-fidelity pediatric simulators for difficult airway management training: a randomized study in continuing medical education. Braz J Anesthesiol 2021; 73:250-257. [PMID: 34089749 DOI: 10.1016/j.bjane.2021.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 04/30/2021] [Accepted: 05/08/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND High-fidelity (HF) pediatric patient simulators are expensive. This randomized study aimed to compare the quality and educational impact of a full-scale simulation workshop with an HF infant simulator (SimBaby™, Laerdal) or with a low-cost (LC) simulator composed of an inert infant manikin with SimBaby™ software that displays respiratory/hemodynamic parameters on a monitor for medical education in pediatric difficult airway management. METHODS After written informed consent, anesthetists and emergency or ICU physicians participated in teams (4 to 6 participants) in a training session that included direct participation and observation of two difficult intubation scenarios. They were randomized into two groups (HF group, n = 65 and LC group, n = 63). They filled out a simulation quality score (SQS, 0 to 50), self-evaluated their anesthetists' non-technical skills (ANTS) score (15 to 60), and an educational quality score (EQS, 0 to 60) immediately (T0, main criteria), as well as 3 (T3) and 6 (T6) months after the training session. RESULTS We enrolled 128 physicians. Direct participation SQS (39 ± 5 HF group versus 38 ± 5 LC group), observation SQS (41 ± 4 H F group versus 39 ± 5 LC group), ANTS scores (38 ± 4 HF group versus 39 ± 6 LC group), T0 SQS (44 ± 5 HF group versus 43 ± 6 LC group), T3 and T6 SQS were not different between groups. CONCLUSION Our low-cost simulator should be suggested as a less expensive alternative to an HF simulator for continuing medical education in pediatric difficult airway management.
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Affiliation(s)
- Corinne Lejus-Bourdeau
- CHU Nantes, Hôtel Dieu - Hôpital Mère Enfant, Service d'Anesthésie Réanimation Chirurgicale, Nantes, France; Laboratoire Expérimental de Simulation de Médecine Intensive de l'Université (LESiMU) de Nantes, Nantes, France.
| | - Florence Pousset
- CHU Nantes, Hôtel Dieu - Hôpital Mère Enfant, Service d'Anesthésie Réanimation Chirurgicale, Nantes, France; Laboratoire Expérimental de Simulation de Médecine Intensive de l'Université (LESiMU) de Nantes, Nantes, France
| | - Cécile Magne
- CHU Nantes, Hôtel Dieu - Hôpital Mère Enfant, Service d'Anesthésie Réanimation Chirurgicale, Nantes, France; Laboratoire Expérimental de Simulation de Médecine Intensive de l'Université (LESiMU) de Nantes, Nantes, France
| | - Olivier Bazin
- Laboratoire Expérimental de Simulation de Médecine Intensive de l'Université (LESiMU) de Nantes, Nantes, France
| | - Nicolas Grillot
- CHU Nantes, Hôtel Dieu - Hôpital Mère Enfant, Service d'Anesthésie Réanimation Chirurgicale, Nantes, France; Laboratoire Expérimental de Simulation de Médecine Intensive de l'Université (LESiMU) de Nantes, Nantes, France
| | - Vincent Pichenot
- CHU Nantes, Hôtel Dieu - Hôpital Mère Enfant, Service d'Anesthésie Réanimation Chirurgicale, Nantes, France; Laboratoire Expérimental de Simulation de Médecine Intensive de l'Université (LESiMU) de Nantes, Nantes, France
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7
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Di Cicco M, Kantar A, Masini B, Nuzzi G, Ragazzo V, Peroni D. Structural and functional development in airways throughout childhood: Children are not small adults. Pediatr Pulmonol 2021; 56:240-251. [PMID: 33179415 DOI: 10.1002/ppul.25169] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/30/2020] [Accepted: 11/09/2020] [Indexed: 12/19/2022]
Abstract
Children are not small adults and this fact is particularly true when we consider the respiratory tract. The anatomic peculiarities of the upper airway make infants preferential nasal breathers between 2 and 6 months of life. The pediatric larynx has a more complex shape than previously believed, with the narrowest point located anatomically at the subglottic level and functionally at the cricoid cartilage. Alveolarization of the distal airways starts conventionally at 36-37 weeks of gestation, but occurs mainly after birth, continuing until adolescence. The pediatric chest wall has unique features that are particularly pronounced in infants. Neonates, infants, and toddlers have a higher metabolic rate, and consequently, their oxygen consumption at rest is more than double that of adults. The main anatomical and functional differences between pediatric and adult airways contribute to the understanding of various respiratory symptoms and disease conditions in childhood. Knowing the peculiarities of pediatric airways is helpful in the prevention, management, and treatment of acute and chronic diseases of the respiratory tract. Developmental modifications in the structure of the respiratory tract, in addition to immunological and neurological maturation, should be taken into consideration during childhood.
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Affiliation(s)
- Maria Di Cicco
- Allergology Section, Paediatrics Unit, Pisa University Hospital, Pisa, Italy.,Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Ahmad Kantar
- Paediatric Asthma and Cough Centre, Istituti Ospedalieri Bergamaschi, Gruppo Ospedaliero San Donato, Bergamo, Italy.,Nursing School, Vita-Salute San Raffaele University, Milan, Italy
| | - Beatrice Masini
- Allergology Section, Paediatrics Unit, Pisa University Hospital, Pisa, Italy.,Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giulia Nuzzi
- Allergology Section, Paediatrics Unit, Pisa University Hospital, Pisa, Italy.,Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Vincenzo Ragazzo
- Paediatrics and Neonatology Division, Women's and Children's Health Department, Versilia Hospital, Lido di Camaiore, Italy
| | - Diego Peroni
- Allergology Section, Paediatrics Unit, Pisa University Hospital, Pisa, Italy.,Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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8
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Heninger J, Phillips M, Huang A, Jagannathan N. Management of the Difficult Pediatric Airway. CURRENT ANESTHESIOLOGY REPORTS 2020. [DOI: 10.1007/s40140-020-00408-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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9
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Long E, Barrett MJ, Peters C, Sabato S, Lockie F. Emergency intubation of children outside of the operating room. Paediatr Anaesth 2020; 30:319-330. [PMID: 31834647 DOI: 10.1111/pan.13784] [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: 11/11/2019] [Revised: 12/02/2019] [Accepted: 12/06/2019] [Indexed: 12/19/2022]
Abstract
Intubation of children outside of the operating room is performed infrequently and is often associated with life-threatening adverse events. This review aims to clarify the contributors to adverse events encountered during intubations outside of the operating room and provide preventative strategies. The primary contributors to adverse events during non-operating room intubations are physiologically and situationally difficult airways; anatomically difficult airways are rare. Systems-based changes, including a shared mental model, standardization in equipment and its location, checklist use, physiological resuscitation prior to resuscitation, dose titration of induction agent, multi-disciplinary team training in the technical and nontechnical aspects of non-operating room intubation, debrief post-real and simulated events, and regular audit of performance all reduce life-threatening intubation-related adverse events in children. Intubation of children outside of the operating room may be performed safely through engagement of all critical care specialties, shared learning, and focus on patient-centered care delivery.
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Affiliation(s)
- Elliot Long
- Department of Emergency Medicine, The Royal Children's Hospital, Parkville, Vic., Australia.,Murdoch Children's Research Institute, Parkville, Vic., Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, Vic., Australia
| | - Michael J Barrett
- Department of Emergency Medicine, Children's Health Ireland at Crumlin, Dublin, Ireland.,National Children's Research Centre, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
| | - Cheryl Peters
- Pediatric Anesthesiology and Intensive Care, British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Stefan Sabato
- Murdoch Children's Research Institute, Parkville, Vic., Australia.,Department of Anaesthesia and Pain Management, The Royal Children's Hospital, Parkville, Vic., Australia
| | - Francis Lockie
- Paediatric Emergency Department, Womens and Childrens Hospital, Adelaide, SA, Australia.,South Australia Ambulance Service MedSTAR Kids Emergency Retrieval, Adelaide, SA, Australia
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10
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Manyumwa P, Chimhundu-Sithole T, Marange-Chikuni D, Evans FM. Adaptations in pediatric anesthesia care and airway management in the resource-poor setting. Paediatr Anaesth 2020; 30:241-247. [PMID: 31910309 DOI: 10.1111/pan.13824] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 01/01/2020] [Accepted: 01/02/2020] [Indexed: 12/17/2022]
Abstract
The need for safe and quality pediatric anesthesia care in low- and middle-income countries (LMICs) is huge. An estimated 1.7 billion children do not have access to surgical care, and the majority are in LMICs. In addition, most LMICs do not have the requisite surgical workforce including anesthesia providers. Surgery is usually performed at three levels of facilities: district, provincial, and national referral hospitals. Unfortunately, the manpower, equipment, and other resources available to provide surgical care for children vary greatly at the different level facilities. The majority of district level hospitals are staffed solely by non-physician anesthesia providers with variable training and little support to manage complicated pediatric patients. Airway and respiratory complications are known to account for a large portion of pediatric perioperative complications. Management of the difficult pediatric airway pathology is a challenge for anesthesia providers regardless of setting. However, in the low-resource setting poor infrastructure, lack of transportation systems, and crippled referral systems lead to late presentation. There is often a lack of pediatric-sized anesthesia equipment and resources, making management of the local pathology even more challenging. Efforts are being made to offer these providers additional training in pediatric anesthesia skills that incorporate low-fidelity simulation. Out of necessity, anesthesia providers in this setting learn to be resourceful in order to manage complex pathologies with fewer, less ideal resources while still providing a safe anesthetic.
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Affiliation(s)
| | - Tsitsi Chimhundu-Sithole
- Department of Anesthesia and Critical Care Medicine, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Danai Marange-Chikuni
- Department of Anesthesia and Critical Care Medicine, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Faye M Evans
- The Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, USA
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11
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Sharma K, Ganapathy U, Gupta A, Bagga D. Single-Centre Open-Label Comparative Trial of Video-Assisted Fibreoptic-Bronchoscope-Guided Oral Versus Nasal Intubation in Anaesthetised Spontaneously Breathing Paediatric Patients. Turk J Anaesthesiol Reanim 2019; 49:37-43. [PMID: 33718904 PMCID: PMC7932718 DOI: 10.5152/tjar.2019.55453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 08/19/2019] [Indexed: 11/23/2022] Open
Abstract
Objective Flexible fibreoptic intubation is challenging in paediatric patients. Very few studies have compared fibreoptic intubation via oral and nasal routes in children. We hypothesised that the total time to a successful fibreoptic-guided tracheal intubation would be faster through the nasal route when compared to the oral route. Methods Sixty children aged 6–12 years were randomised to receive fibreoptic tracheal intubation through oral (group FOI) or nasal route (group FNI). We measured the time to glottic view and total time to successful tracheal intubation. The number of attempts needed, first attempt and overall success rate, external manoeuvres needed to obtain an adequate laryngeal view, subjective assessment of ease of intubation and complications, if any, were also recorded. Results The time to glottic view (76.26±.7 s vs. 46.33±16.9 s; p=0.001) and total intubation time (4.55±1.07 min vs. 3.05±0.60 min; p<0.0001) were significantly higher in the FOI group as compared to the FNI group. An overall success rate was 100% in the FNI group and 96.6% in the FOI group. The haemodynamic parameters (mean heart rate and blood pressures) changes were comparable in the two groups at all time intervals. The subjective assessment of ease of intubation was comparable in the two groups (p=0.21). Complications were minor and self-limiting. Conclusion Intubation guided by a nasal flexible fibreoptic bronchoscope is easier and faster when compared to oral intubation in children aged 6–12 years with normal airway, and it should be preferred for intubation in children requiring fibreoptic intubation.
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Affiliation(s)
- Kirti Sharma
- Department of Anaesthesiology and Critical Care, VMMC and Safdarjung Hospital, Delhi, India
| | - Usha Ganapathy
- Department of Anaesthesiology and Critical Care, VMMC and Safdarjung Hospital, Delhi, India
| | - Anju Gupta
- Department of Anaesthesiology, Pain and Critical Care, AIIMS, New Delhi, India
| | - Deepak Bagga
- Department of Paediatric Surgery, VMMC and Safdarjung Hospital, Delhi, India
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12
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Matsumura T, Suzuki C, Kubota K, Minakuchi S, Fukayama H. Difficult Nasal Intubation Using Airway Scope ® for a Child With Large Tumor. Anesth Prog 2019; 65:251-254. [PMID: 30715950 DOI: 10.2344/anpr-65-04-08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
We report a case of difficult nasal intubation utilizing a Pentax-Airway scope® AWS-100. A 4-month-old female with a rapidly growing melanotic neuroectodermal tumor was scheduled for resection under general anesthesia. The tumor was a large rubbery mass located in the middle of the mandible. For nasal intubation using the AWS, guidance of the tube toward the glottis was attempted using pediatric Magill forceps. Although we could hold the tube with the Magill forceps, it was difficult to insert the tube into the trachea due to the limited space in her hypopharynx. We then used a standard laryngoscope with a Miller straight blade for direct visual laryngoscopy and successfully intubated the patient with the aid of the pediatric Magill forceps. We often experience difficulty navigating a nasal endotracheal tube toward the glottis even when a clear glottic view is obtained with video laryngoscopes, especially in children with a small oropharyngeal space. However, some reports have been shown that video laryngoscopes are useful for intubation of the difficult airway and causes less stress to the upper airway than direct visual laryngoscopy. Video laryngoscopy can be an excellent way to provide nasal intubation in some but not all children.
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Affiliation(s)
- Tomoka Matsumura
- Anesthesiology and Clinical Physiology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Chihiro Suzuki
- Anesthesiology and Clinical Physiology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kazumasa Kubota
- Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shunsuke Minakuchi
- Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Haruhisa Fukayama
- Anesthesiology and Clinical Physiology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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13
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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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14
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Abstract
BACKGROUND Extracranial carotid aneurysms in children are extremely rare but carry a high mortality and morbidity. For pediatric patients, they are often complications of pharyngeal infections and surgical trauma but can also arise from congenital and inflammatory diseases. They have a wide range of presentation from an asymptomatic mass to a rapidly fatal hemorrhage. CASE A 10-year-old boy presented to the emergency department with complaints of a neck mass and residual cough from a recent upper respiratory infection. Ultrasound revealed a carotid aneurysm that was further characterized by magnetic resonance angiography as a 3-cm aneurysm of the internal carotid artery. The patient was taken for surgery where he underwent resection and placement of an interposition graft. The procedure was well tolerated and the boy recovered fully. DISCUSSION Carotid aneurysms in children can present with 1 or more of the following: a pulsatile neck mass, hematemesis, epistaxis, neurologic symptoms, and symptoms of airway compression. Although ultrasound is the preferred initial test, the choice of additional imaging for further characterization will depend most on the patient age, hemodynamic stability, airway status, and availability of pediatric anesthesia. Hemodynamic and neurologic status should be monitored closely, and clinicians must also be prepared for a potentially complicated airway. Surgery is indicated for children owing to high risk of neurologic complications. CONCLUSIONS Although these lesions are rare, it is crucial that physicians recognize when there is a need for further evaluation so that these children have the most favorable outcomes possible.
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15
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Use of Awake Flexible Fiberoptic Bronchoscopic Nasal Intubation in Secure Airway Management for Reconstructive Surgery in a Pediatric Patient with Burn Contracture of the Neck. Case Rep Anesthesiol 2018; 2018:8981561. [PMID: 30420923 PMCID: PMC6215584 DOI: 10.1155/2018/8981561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 09/20/2018] [Indexed: 11/26/2022] Open
Abstract
Although the use of awake flexible fiberoptic bronchoscopic (FFB) intubation is a well-recognized airway management technique in patients with difficult airway, its use in smaller children with burn contractures or in an uncooperative older child may be challenging. Herein, we report successful management of difficult airway in a 7-year-old boy with burn contracture of the neck, by application of FFB nasal intubation in a stepwise approach, first during an initial preoperative trial phase to increase patient cooperation and then during anesthesia induction for the reconstructive surgery planned for burn scars and contractures. Our findings emphasize the importance of a preplanned algorithm for airway control in secure airway management and feasibility of awake FFB intubation in a pediatric patient with burn contracture of the neck during anesthesia induction for reconstructive surgery. Application of FFB intubation based on a stepwise approach including a trial phase prior to operation day seemed to increase the chance of a successful intubation in our patient in terms of technical expertise and increased patient cooperation and tolerance by enabling familiarity with the procedure.
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Management of Young Patients with Temporomandibular Joint Ankylosis-a Surgical and Anesthetic Challenge. Indian J Surg 2016; 78:482-489. [PMID: 28100946 DOI: 10.1007/s12262-016-1551-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 10/05/2016] [Indexed: 12/19/2022] Open
Abstract
Temporomandibular joint ankylosis is a unique disease where fracture of the mandibular condyle or any other cause leading to ankylosis of the joint can lead to multiple problems if not detected and treated early. If affected in early years of life, it may cause facial dysmorphism, restricted mouth opening, and difficulty in eating, speech, and sleep. Early surgery and physiotherapy can restore the joint function to a great extent. Anesthetizing a pediatric patient with this disorder is a definite challenge which needs expertise in difficult airway management.
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Patel MM, Kamat PP, McCracken CE, Simon HK. Complications of Deep Sedation for Individual Procedures (Lumbar Puncture Alone) Versus Combined Procedures (Lumbar Puncture and Bone Marrow Aspirate) in Pediatric Oncology Patients. Hosp Pediatr 2016; 6:95-102. [PMID: 26769714 DOI: 10.1542/hpeds.2015-0065] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Pediatric oncology patients frequently undergo procedural sedation. The goal of this study was to determine the safety of combining procedures into a single sedation encounter and to assess if the magnitude of any complication is significant enough to justify separate sedation encounters for multiple procedures. METHODS This retrospective review included pediatric oncology patients sedated for lumbar puncture alone or combined procedures (lumbar puncture and bone marrow aspirate) from January 2012 to January 2014. Demographic characteristics, medication dosing, procedural success, sedation duration, and adverse events (AEs) with associated required interventions were recorded. Sedation-related complications were separated into serious adverse events (SAEs) and AEs. Data were analyzed by using multivariable modeling. RESULTS Data from 972 sedation encounters involving 96 patients, each having 1 to 28 encounters (mean±SD, 10±5), were reviewed. Ninety percent were individual procedures and 10% were combined procedures. Overall, there were few SAEs, and airway obstruction was the most common SAE. Combined procedures required 0.31 mg/kg more propofol (P<.001) and took 1.4 times longer (P<.001) than individual procedures. In addition, when adjusting for possible confounding factors, the odds of having an SAE were 4.8 (95% confidence interval, 1.37-16.65); P=.014) times higher for combined procedures. All SAEs and AEs were manageable by the sedation team. CONCLUSIONS Combining procedures was associated with higher propofol doses, prolonged duration, and a small increase in likelihood of SAEs compared with individual procedures. All AEs fell within the scope of management by the sedation team. Balancing the increased, but manageable, risks versus the advantages of family/patient convenience, enhanced resource utilization, and minimization of potential neurotoxicity from anesthetics supports combining procedures when possible.
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Affiliation(s)
| | - Pradip P Kamat
- Departments of Pediatrics, and Children's Healthcare of Atlanta, Atlanta, Georgia
| | | | - Harold K Simon
- Departments of Pediatrics, and Children's Healthcare of Atlanta, Atlanta, Georgia Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia; and
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Klučka J, Štourač P, Štoudek R, Ťoukálková M, Harazim H, Kosinová M. Controversies in Pediatric Perioperative Airways. BIOMED RESEARCH INTERNATIONAL 2015; 2015:368761. [PMID: 26759809 PMCID: PMC4670638 DOI: 10.1155/2015/368761] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 10/09/2015] [Accepted: 10/11/2015] [Indexed: 12/17/2022]
Abstract
Pediatric airway management is a challenge in routine anesthesia practice. Any airway-related complication due to improper procedure can have catastrophic consequences in pediatric patients. The authors reviewed the current relevant literature using the following data bases: Google Scholar, PubMed, Medline (OVID SP), and Dynamed, and the following keywords: Airway/s, Children, Pediatric, Difficult Airways, and Controversies. From a summary of the data, we identified several controversies: difficult airway prediction, difficult airway management, cuffed versus uncuffed endotracheal tubes for securing pediatric airways, rapid sequence induction (RSI), laryngeal mask versus endotracheal tube, and extubation timing. The data show that pediatric anesthesia practice in perioperative airway management is currently lacking the strong evidence-based medicine (EBM) data that is available for adult subpopulations. A number of procedural steps in airway management are derived only from adult populations. However, the objective is the same irrespective of patient age: proper securing of the airway and oxygenation of the patient.
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Affiliation(s)
- Jozef Klučka
- Department of Pediatric Anesthesiology and Intensive Care Medicine, Medical Faculty of Masaryk University and University Hospital Brno, Cernopolni 9, 613 00 Brno, Czech Republic
| | - Petr Štourač
- Department of Pediatric Anesthesiology and Intensive Care Medicine, Medical Faculty of Masaryk University and University Hospital Brno, Cernopolni 9, 613 00 Brno, Czech Republic
| | - Roman Štoudek
- Department of Pediatric Anesthesiology and Intensive Care Medicine, Medical Faculty of Masaryk University and University Hospital Brno, Cernopolni 9, 613 00 Brno, Czech Republic
| | - Michaela Ťoukálková
- Department of Pediatric Anesthesiology and Intensive Care Medicine, Medical Faculty of Masaryk University and University Hospital Brno, Cernopolni 9, 613 00 Brno, Czech Republic
| | - Hana Harazim
- Department of Anesthesiology and Intensive Care Medicine, Medical Faculty of Masaryk University and University Hospital Brno, Jihlavska 20, 625 00 Brno, Czech Republic
| | - Martina Kosinová
- Department of Anesthesiology and Intensive Care Medicine, Medical Faculty of Masaryk University and University Hospital Brno, Jihlavska 20, 625 00 Brno, Czech Republic
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Pediatric critical care physician-administered procedural sedation using propofol: a report from the Pediatric Sedation Research Consortium Database. Pediatr Crit Care Med 2015; 16:11-20. [PMID: 25340297 DOI: 10.1097/pcc.0000000000000273] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Increasing demand for pediatric procedural sedation has resulted in a marked increase in provision of pediatric procedural sedation by pediatric critical care physicians both inside and outside of the ICU. Reported experience of pediatric critical care physicians-administered pediatric procedural sedation is limited. We used the Pediatric Sedation Research Consortium database to evaluate a multicenter experience with propofol by pediatric critical care physicians in all settings. SETTING Review of national Pediatric Sedation Research Consortium database to identify pediatric procedural sedation provided by pediatric critical care physicians from 2007 to 2012. Demographic and clinical data were collected to describe pediatric procedural sedation selection, location, and delivery. Multivariable logistic regression analysis was performed to identify risk factors associated with pediatric procedural sedation-related adverse events and complications. MEASUREMENTS AND MAIN RESULTS A total of 91,189 pediatric procedural sedation performed by pediatric critical care physicians using propofol were included in the database. Median age was 60.0 months (range, 0-264 months; interquartile range, 34.0-132.0); 81.9% of patients were American Society of Anesthesiologists class I or II. Most sedations were performed in dedicated sedation or radiology units (80.9%). Procedures were successfully completed in 99.9% of patients. A propofol bolus alone was used in 52.8%, and 41.7% received bolus plus continuous infusion. Commonly used adjunctive medications were lidocaine (35.3%), opioids (23.3%), and benzodiazepines (16.4%). Overall adverse event incidence was 5.0% (95% CI, 4.9-5.2%), which included airway obstruction (1.6%), desaturation (1.5%), coughing (1.0%), and emergent airway intervention (0.7%). No deaths occurred; a single cardiac arrest was reported in a 13-month-old child receiving propofol and ketamine, with no untoward neurologic sequelae. Risk factors associated with adverse event included: location of sedation, number of adjunctive medications, upper and lower respiratory diagnosis, prematurity diagnosis, weight, American Society of Anesthesiologists status, and painful procedure. CONCLUSIONS Pediatric procedural sedation using propofol can be provided by pediatric critical care physicians effectively and with a low incidence of adverse events.
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Jagannathan N, Sequera-Ramos L, Sohn L, Huang A, Sawardekar A, Wasson N, Miriyala A, De Oliveira GS. Randomized comparison of experts and trainees with nasal and oral fibreoptic intubation in children less than 2 yr of age. Br J Anaesth 2014; 114:290-6. [PMID: 25377166 DOI: 10.1093/bja/aeu370] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND We hypothesized that the time to successful fibreoptic tracheal intubation through the nasal route would be faster than the oral route for both experts and trainees in children <2 yr of age. METHODS One hundred children, 24 months and under in age, were randomized to an operator (expert or trainee), and route (nasal or oral) for fibreoptic tracheal intubation. Three separate times were then measured: (i) time to first glottic view, (ii) time to carinal view, and (iii) total time to successful tracheal intubation. The number of attempts made, manoeuvres needed to obtain an adequate laryngeal view, and manoeuvres for tracheal tube passage were also recorded. RESULTS Time to successful tracheal intubation was significantly faster for experts than trainees. There was no difference in the time to tracheal intubation between the nasal and oral routes for experts. In trainees, intubation times were shorter for the nasal route-median (inter-quartile range) time (s) to carinal view was 35 (27-63) for the nasal route vs 59 (38-94) for the oral route (P=0.03), and the median time to successful tracheal intubation were 62 (49-122) vs 117 (61-224), P=0.05, for the nasal and oral routes, respectively. For trainees, the oral route required a greater number of airway manoeuvres for adequate laryngeal views and passage of the tracheal tube compared with the nasal route. CONCLUSIONS For clinicians with less experience in using paediatric bronchoscopes, fibreoptic tracheal intubation through the nasal route may be a more straightforward process than the oral route in children <2 yr of age. CLINICAL TRIAL REGISTRATION NCT02029300 (www.clinicaltrials.gov).
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Affiliation(s)
- N Jagannathan
- Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Box 19, Chicago, IL, USA
| | - L Sequera-Ramos
- Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Box 19, Chicago, IL, USA
| | - L Sohn
- Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Box 19, Chicago, IL, USA
| | - A Huang
- Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Box 19, Chicago, IL, USA
| | - A Sawardekar
- Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Box 19, Chicago, IL, USA
| | - N Wasson
- Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Box 19, Chicago, IL, USA
| | - A Miriyala
- Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Box 19, Chicago, IL, USA
| | - G S De Oliveira
- Feinberg School of Medicine, Northwestern University, 303 E Chicago Ave, Chicago, IL 60611, USA
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Abstract
Care of the ill and injured child requires knowledge of unique pediatric anatomic and physiologic differences. Subtleties in presentation and pathophysiologic differences impact management. This article discusses pediatric resuscitation, the presentation and management of common childhood illness, pediatric trauma, and common procedures required in the critically ill child.
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Davies K, Monterosso L, Bulsara M, Ramelet AS. Clinical indicators for the initiation of endotracheal suction in children: An integrative review. Aust Crit Care 2014; 28:11-8. [PMID: 24767960 DOI: 10.1016/j.aucc.2014.03.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 03/05/2014] [Accepted: 03/18/2014] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Critical decisions and interpretation of observations by the nurse caring for the paediatric intensive care (PIC) patient can have dramatic and potential adverse impact on the clinical stability of the patient. A common PIC procedure is endotracheal tube (ETT) suction, however there is inconsistent evidence regarding the clinical indicators to guide and support nursing action. Justification for performing this procedure is not clearly defined within the literature. Further, a review of the literature has failed to establish clear standards for determining if the procedure is warranted, especially for paediatric patients. OBJECTIVE The objective of the review is to identify current clinical indicators used in practice to determine why ETT suction should be performed. METHOD An integrative review using a systematic approach to summarise the empirical and theoretical evidence within the literature as it relates to clinical practice was used. RESULTS Consensus of opinion indicates that ETT suctioning should only be performed when clinically indicated. There is no general consensus regarding which clinical indicators should be measured and used to guide the decision to perform ETT suctioning. CONCLUSION Research is required to identify the clinical indicators that could be used to design a valid and clinically appropriate tool to use to assist in the decision making process to perform ETT suction.
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Affiliation(s)
- K Davies
- Paediatric Intensive Care Unit, Princess Margaret Hospital for Children, Perth, Australia.
| | - L Monterosso
- School of Nursing and Midwifery, The University of Notre Dame Australia, Edith Cowan University, Australia
| | - M Bulsara
- Institute of Health and Rehabilitation Research, The University of Notre Dame Australia, Australia
| | - A S Ramelet
- Institute of Higher Education and Nursing Research, Faculty of Biology and Medicine, University of Lausanne, Switzerland
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Abstract
Securing an airway is a vital task for the anesthesiologist. The pediatric patients have significant anatomical and physiological differences compared with adults, which impact on the techniques and tools that the anesthesiologist might choose to provide safe and effective control of the airway. Furthermore, there are a number of pathological processes, typically seen in the pediatric population, which present unique anatomical or functional difficulties in airway management. The presence of one of these syndromes or conditions can predict a "difficult airway." Many instruments and devices are currently available which have been designed to aid in airway management. Some of these have been adapted from adult designs, but in many cases require alterations in technique to account for the anatomical and physiological differences of the pediatric patient. This review focuses on assessment and management of pediatric airway and highlights the unique challenges encountered in children.
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Affiliation(s)
- Jeff Harless
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Ramesh Ramaiah
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Sanjay M Bhananker
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, Washington, USA
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Failure of the Laryngeal Mask Airway Unique™ and Classic™ in the Pediatric Surgical Patient. Anesthesiology 2013; 119:1284-95. [DOI: 10.1097/aln.0000000000000015] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Abstract
Background:
Although predictors of laryngeal mask airway failure in adults have been elucidated, there remains a paucity of data regarding laryngeal mask airway failure in children.
Methods:
The authors performed a retrospective database review of all pediatric patients who received a laryngeal mask anesthetic at their institution from 2006 to 2010. Device brands were restricted to LMA Unique™ (Cardinal Health, Dublin, OH) and LMA Classic™ (LMA North America, San Diego, CA), and primary outcome was laryngeal mask failure, defined as any airway event requiring device removal and tracheal intubation. Potential risk factors were analyzed with both univariate and multivariate techniques and included medical history, physical examination, surgical, and anesthetic characteristics.
Results:
Of the 11,910 anesthesia cases performed in the study, 102 cases (0.86%) experienced laryngeal mask failure. Common presenting features of laryngeal mask failures included leak (25%), obstruction (48%), and patient intolerance such as intractable coughing/bucking (11%). Failures occurred before incision in 57% of cases and after incision in 43%. Independent clinical associations included ear/nose/throat surgical procedure, nonoutpatient admission status, prolonged surgical duration, congenital/acquired airway abnormality, and patient transport.
Conclusions:
The findings of the study support the use of the LMA Unique™ and LMA Classic™ as reliable pediatric supraglottic airway devices, demonstrating relatively low failure rates. Predictors of laryngeal mask airway failure in the pediatric surgical population do not overlap with those in the adult population and should therefore be independently considered.
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Zimmerman KO, Hupp SR, Bourguet-Vincent A, Bressler EA, Raynor EM, Turner DA, Rehder KJ. Acute upper-airway obstruction by a lingual thyroglossal duct cyst and implications for advanced airway management. Respir Care 2013; 59:e98-e102. [PMID: 24170914 DOI: 10.4187/respcare.02513] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
| | - Susan R Hupp
- Division of Pediatric Critical Care Medicine, Department of Pediatrics
| | | | | | - Eileen M Raynor
- Division of Otolaryngology, Department of Pediatric Surgery, Duke Children's Hospital, Durham, North Carolina
| | - David A Turner
- Division of Pediatric Critical Care Medicine, Department of Pediatrics
| | - Kyle J Rehder
- Division of Pediatric Critical Care Medicine, Department of Pediatrics
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Sunder RA, Haile DT, Farrell PT, Sharma A. Pediatric airway management: current practices and future directions. Paediatr Anaesth 2012; 22:1008-15. [PMID: 22967160 DOI: 10.1111/pan.12013] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Management of a pediatric airway can be a challenge, especially for the non-pediatric anesthesiologists. Structured algorithms for an unexpected difficult pediatric airway have been missing so far. A recent step wise algorithm, based on the Difficult Airway society (DAS) adult protocol, is a step in the right direction. There have been some exciting advances in development of pediatric extra-glottic devices for maintaining ventilation, and introduction of pediatric versions of new 'non line of sight' laryngoscopes and optical stylets. The exact role of these devices in routine and emergent situations is still evolving. Recent advances in simulation technology has become a valuable tool in imparting psychomotor and procedural skills to trainees and allied healthcare workers. Moving toward the goal of eliminating serious adverse events during the management of routine and difficult pediatric airway, authors propose that institutions develop a dedicated Difficult Airway Service comprising of a team of experts in advanced airway management.
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Affiliation(s)
- Rani A Sunder
- Division of Pediatric Anesthesiology, Washington University at St Louis, St Louis, MO 63105, USA
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Morton NS. Editorial: a special tribute to Isabelle Murat and Martin Jöhr. Paediatr Anaesth 2012; 22:509-10. [PMID: 22594403 DOI: 10.1111/j.1460-9592.2012.03882.x] [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] [Indexed: 11/27/2022]
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