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Kim J, Jeon S. Nasotracheal intubation in pediatrics: a narrative review. J Dent Anesth Pain Med 2024; 24:81-90. [PMID: 38584754 PMCID: PMC10995536 DOI: 10.17245/jdapm.2024.24.2.81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 03/03/2024] [Accepted: 03/10/2024] [Indexed: 04/09/2024] Open
Abstract
Nasotracheal intubation (NTI) plays an important role in pediatric airway management, offering advantages in specific situations, such as oral and maxillofacial surgery and situations requiring stable tube positioning. However, compared to adults, NTI in children presents unique challenges owing to anatomical differences and limited space. This limited space, in combination with a large tongue and short mandible, along with large tonsils and adenoids, can complicate intubation. Owing to the short tracheal length in pediatric patients, it is crucial to place the tube at the correct depth to prevent it from being displaced due to neck movements, and causing injury to the glottis. The equipment used for NTI includes different tube types, direct laryngoscopy vs. video laryngoscopy, and fiberoptic bronchoscopy. Considering pediatric anatomy, the advantages of video laryngoscopy have been questioned. Studies comparing different techniques have provided insights into their efficacy. Determining the appropriate size and depth of nasotracheal tubes for pediatric patients remains a challenge. Various formulas based on age, weight, and height have been explored, including the recommendation of depth-mark-based NTI. This review provides a comprehensive overview of NTI in pediatric patients, including the relevant anatomy, equipment, clinical judgment, and possible complications.
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Affiliation(s)
- Jieun Kim
- National Dental Care Center for Persons with Special Needs, Seoul National University Dental Hospital, Seoul, Republic of Korea
| | - Sooyoung Jeon
- National Dental Care Center for Persons with Special Needs, Seoul National University Dental Hospital, Seoul, Republic of Korea
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Takeuchi R, Hoshijima H, Mihara T, Kokubu S, Sato (Boku) A, Nagumo T, Mieda T, Shiga T, Mizuta K. Comparison of Indirect and Direct Laryngoscopes in Pediatric Patients with a Difficult Airway: A Systematic Review and Meta-Analysis. CHILDREN (BASEL, SWITZERLAND) 2023; 11:60. [PMID: 38255373 PMCID: PMC10814718 DOI: 10.3390/children11010060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 12/26/2023] [Indexed: 01/24/2024]
Abstract
This meta-analysis was performed to determine whether an indirect laryngoscope is more advantageous than a direct laryngoscope for tracheal intubation in the setting of a difficult pediatric airway. Data on the intubation failure and intubation time during tracheal intubation were extracted from prospective and retrospective studies identified through a comprehensive literature search. Data from 10 individual articles (11 trials) were combined, and a DerSimonian and Laird random-effects model was used to calculate either the pooled relative risk (RR) or the weighted mean difference (WMD) and the corresponding 95% confidence interval (CI). Meta-analysis of the 10 articles indicated that the intubation failure of tracheal intubation with an indirect laryngoscope was not significantly different from that of a direct laryngoscope in patients with a difficult airway (RR 0.86, 95% CI 0.51-1.46; p = 0.59; Cochrane's Q = 50.5; I2 = 82%). Intubation time with an indirect laryngoscope was also similar to that with a direct laryngoscope (WMD 4.06 s; 95% CI -1.18-9.30; p = 0.13; Cochrane's Q 39.8; I2 = 85%). In conclusion, indirect laryngoscopes had the same intubation failure and intubation time as direct laryngoscopes in pediatric patients with a difficult airway. Currently, the benefits of indirect laryngoscopes have not been observed in the setting of a difficult pediatric airway.
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Affiliation(s)
- Risa Takeuchi
- Bunkoukai Special Needs Center, 2765-5 Ujiie, Sakura 329-1311, Tochigi, Japan; (R.T.); (K.M.)
| | - Hiroshi Hoshijima
- Division of Dento-Oral Anesthesiology, Graduate School of Dentistry, Tohoku University, 4-1 Seiryomachi, Aoba, Sendai 980-8575, Miyagi, Japan
| | - Takahiro Mihara
- Department of Health Data Science, Graduate School of Data Science, Yokohama City University, Yokohama 236-0004, Kanagawa, Japan;
| | - Shinichi Kokubu
- Department of Anesthesiology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsugagun 321-0293, Tochigi, Japan;
| | - Aiji Sato (Boku)
- Department of Anesthesiology, School of Dentistry, Aichi Gakuin University, 2-11 Suemori-dori, Chikusa-ku, Nagoya 465-8651, Aichi, Japan;
| | - Takumi Nagumo
- Department of Anesthesiology, Saitama Medical University Hospital, Irumagun 350-0495, Saitama, Japan; (T.N.); (T.M.)
| | - Tsutomu Mieda
- Department of Anesthesiology, Saitama Medical University Hospital, Irumagun 350-0495, Saitama, Japan; (T.N.); (T.M.)
| | - Toshiya Shiga
- Department of Anesthesiology and Pain Medicine, International University of Health and Welfare Ichikawa Hospital, 6-1-4 Kounodai, Ichikawa 272-0827, Chiba, Japan;
| | - Kentaro Mizuta
- Bunkoukai Special Needs Center, 2765-5 Ujiie, Sakura 329-1311, Tochigi, Japan; (R.T.); (K.M.)
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