Airway Management In Pediatric Patients Research Articles

Airway management in pediatric patients with a rigid external distractor in situ

Pediatric AnesthesiaVolume 21, Issue 6 p. 699-700 CORRESPONDENCE Airway management in pediatric patients with a rigid external distractor in situ Fu Shan Xue, Fu Shan Xue Both authors contributed equally to this work.Search for more papers by this authorXu Liao, Xu Liao Both authors contributed equally to this work.Search for more papers by this authorJian Hua Liu, Jian Hua Liu Department of Anesthesiology, Plastic Surgery Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,33 Ba-Da-Chu Road, Shi-Jing-Shan District,Beijing 100144, ChinaEmail: [email protected]Search for more papers by this authorYu Jing Yuan, Yu Jing Yuan Department of Anesthesiology, Plastic Surgery Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,33 Ba-Da-Chu Road, Shi-Jing-Shan District,Beijing 100144, ChinaEmail: [email protected]Search for more papers by this authorQiang Wang, Qiang Wang Department of Anesthesiology, Plastic Surgery Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,33 Ba-Da-Chu Road, Shi-Jing-Shan District,Beijing 100144, ChinaEmail: [email protected]Search for more papers by this author Fu Shan Xue, Fu Shan Xue Both authors contributed equally to this work.Search for more papers by this authorXu Liao, Xu Liao Both authors contributed equally to this work.Search for more papers by this authorJian Hua Liu, Jian Hua Liu Department of Anesthesiology, Plastic Surgery Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,33 Ba-Da-Chu Road, Shi-Jing-Shan District,Beijing 100144, ChinaEmail: [email protected]Search for more papers by this authorYu Jing Yuan, Yu Jing Yuan Department of Anesthesiology, Plastic Surgery Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,33 Ba-Da-Chu Road, Shi-Jing-Shan District,Beijing 100144, ChinaEmail: [email protected]Search for more papers by this authorQiang Wang, Qiang Wang Department of Anesthesiology, Plastic Surgery Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,33 Ba-Da-Chu Road, Shi-Jing-Shan District,Beijing 100144, ChinaEmail: [email protected]Search for more papers by this author First published: 25 April 2011 https://doi.org/10.1111/j.1460-9592.2011.03546.xCitations: 2 Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume21, Issue6June 2011Pages 699-700 RelatedInformation

Airway management in pediatric patients at referring hospitals compared to a receiving tertiary pediatric ICU

Objective To describe the current practice of pediatric airway management at referring hospitals and the associated adverse events compared to a receiving tertiary pediatric ICU. Method Retrospective chart and transport record review of all emergency critical care transports to our Pediatric ICU over 3 years. Data regarding tracheal intubation procedure, pre-defined adverse Tracheal Intubation Associated Events ( TIAEs), and airway events before, during, and after the inter-hospital transport were collected using a standard National Emergency Airway Registry for children (NEAR4KIDS) definition. Tracheal intubation outcomes were compared to in-hospital P ICU intubations. Results 253/1489 (17%) of critical care transports had airway management, all by tracheal intubation. The most common condition was seizure (34%), followed by pulmonary/lower airway disease (16%). 49 (19%) had TIAEs; the most common event was mainstem bronchial intubation (13%). Incidence of TIAEs was similar to PICU ( p = 0.69). Thirteen had an inappropriate tracheal tube position upon PICU arrival, but none experienced accidental extubation during transport. An uncuffed tracheal tube was used in 108/172 (63%) of patients < 8 years, significantly higher than PICU (20%, p < 0.0001). 124 (49%) were extubated within 24 h, 153 (60%) within 48 h. Two patients had the tracheal tube changed to cuffed from uncuffed due to air leak. Conclusion Provider reported adverse TIAEs are common during airway management in children requiring critical care transport, but not higher compared to PICU intubations. Most inter-hospital transport patients are intubated with an uncuffed tracheal tube. Subsequent tracheal tube change from uncuffed to cuffed tube is rarely required.

Airway management in pediatric patients undergoing suspension laryngoscopic surgery for severe laryngeal obstruction caused by papillomatosis

To review perioperative airway management and ventilation strategy during the surgical removal of papilloma under suspension laryngoscopy in pediatric patients with severe airway obstruction. Seventy pediatric patients with degree III and IV laryngeal obstruction who underwent suspension laryngoscopy to remove laryngeal papillomatosis, between July 2005 and March 2009, were included in the study. All patients were intubated initially to secure the airway. Controlled ventilation through an endotracheal (ET) tube was used during the papilloma debulking near the glottis vera. Spontaneous ventilation or apneic technique was adopted based on the stage of the surgical procedure and the location of the remaining tumor. Hemodynamic parameters, pulse oxygen saturation (SpO(2)), and CO(2) were closely monitored, and adverse events were recorded. The duration of the surgical operation and the duration of the extubation period were 5-35 min and 5-20 min, respectively. Thirty cases with degree III and twenty cases with degree IV laryngeal obstruction received inhalation induction. Sixteen cases with degree III laryngeal obstruction were given an intravenous induction. Four patients admitted with a comatose status were emergently intubated without any anesthetics. The ET tube size was determined by assessing the opening through the tumor mass or glottic aperture under direct laryngoscopy. SpO(2) was maintained above 97% after the airway was secured and sufficient ventilation established. Controlled ventilation was used in all children during the bulk removal of tumor. Spontaneous respiration and apneic technique were adopted for the removal of the remaining tumor in the hypolarynx or trachea in 16 and 28 cases, respectively. Three patients had to be re-intubated postoperatively because of persistent desaturation or laryngospasm. Key points of perioperative airway management in pediatric patients with papillomatosis-induced severe laryngeal obstruction include careful preoperative airway evaluation; the proper choice of induction methods, and ET tube size; maintenance of an adequate depth of anesthesia; and flexible ventilation strategy, continuous and close monitoring during the extubation and postextubation period; and prompt management of adverse events.

Proposal for the management of the unexpected difficult pediatric airway

The incidence of unanticipated difficult or failed airway in otherwise healthy children is rare, and routine airway management in pediatric patients is easy in experienced hands. However, difficulties with airway management in healthy children are not infrequent in nonpediatric anesthetists and are a main reason for pediatric anesthesia-related morbidity and mortality. Clear concepts and strategies are, therefore, required to maintain oxygenation and ventilation in children. Several complicated algorithms for the management of the unanticipated difficult adult and pediatric airway have been proposed, but a simple structured algorithm for the pediatric patient with unanticipated difficult airway is missing. This paper proposes a simple step-wise algorithm for the unexpected difficult pediatric airway based on an adult Difficult Airway Society (DAS) protocol, discusses the role of recently introduced airway devices, and suggests a content of a pediatric airway trolley. It is intended as an easy to memorize and a practical guide for the anesthetist only occasionally involved in pediatric anesthesia care as well as a call to stimulate discussion about the management of the unanticipated difficult pediatric airway.

Prevention of aspiration under general anesthesia by use of the size 2½ ProSealTM laryngeal mask airway in a 6‐year‐old boy: a case report

We report a case where use of the size 2 1/2 ProSeal laryngeal mask airway helped to prevent pulmonary aspiration of regurgitated gastric fluid. We describe the management of this case and discuss the potential advantages of this modified laryngeal mask airway for supraglottic airway management in pediatric patients.

Anesthesia and airway management of pediatric patients with Smith-Lemli-Opitz syndrome.

SMITH-LEMLI-OPITZ syndrome (SLOS) is an autosomal recessive disorder with an incidence of between 1 in 26,500 pregnancies in Canada and 1 in 50,000 pregnancies in the United States. The syndrome results from an inborn error of cholesterol biosynthesis involving a deficiency of 3β-hydroxysterol Δ 7 -reductase, the enzyme that catalyzes the reduction of 7-dehydrocholesterol to cholesterol. As a result, patients with SLOS have abnormal embryonic development, high plasma concentrations of 7-dehydrocholesterol, and usually decreased plasma concentrations of cholesterol. This biochemical defect is associated with a broad spectrum of clinical manifestations with potentially profound anesthetic implications. Patients with SLOS cans have severe growth failure, congenital anomalies affecting most organ systems, early death, developmental delay, and self-injurious and ritualistic behavior. Of special concern to anesthesiologists are the typical dysmorphic facial features, including micrognathia, cleft palate, and a small and abnormally hard tongue, which can present a challenge in airway management of patients with SLOS. The broad spectrum of congenital anomalies and potential increase in lifespan with dietary cholesterol replacement therapy make it very likely that diagnostic and therapeutic interventions requirign anesthesia will be needed in patients with SLOS. However, since the discovery of the biochemical defect in SLOS, little has been reported on the anesthetic management of these patients. In this report, we describe the administration of 20 anesthetics in 14 patients with confirmed biochemical diagnosis of SLOS. Our focus was on airway management, and because of previous reports of difficult intubations in some of our patients, we chose to use fiberoptic laryngoscopy as the initial technique to achieve tracheal intubation.

RESUSCITATION UPDATE FOR THE PEDIATRICIAN

Survival and neurologic outcome among pediatric patients in CPA have not improved measurably in the past decade, but the evolution of the pediatric Utstein guidelines has provided those involved in pediatric resuscitation a common language with which to exchange information and hopefully conduct meaningful research. The widespread use of the LMA may hold real promise for airway management of pediatric patients in the prehospital setting. Several of the developments in adult resuscitation, including ACD CPR and IAC CPR, seem auspicious for pediatric patients in cardiac arrest. At first glance, the widespread use of the AED would not be expected to alter the outcome of pediatric patients in CPA, but two studies suggest that ventricular fibrillation is more common in the pediatric population than originally believed, and thus the AED may have a significant role for this group of patients. The value of high-dose epinephrine remains controversial. All of these areas require research in the pediatric population before a judgment on their worth can be made. Research in pediatric resuscitation requires the study of larger populations, most feasibly with multicenter studies. How the "final rule" will influence this type of research remains to be seen. Finally, if investigators are to make real progress in improving the outcome of pediatric patients in CPA, they must concentrate their efforts on education of the lay public and enhancement of prehospital care.

CLASSIFICATION AND ASSESSMENT OF THE DIFFICULT PEDIATRIC AIRWAY

CLASSIFICATION OF THE DIFFICULT AIRWAY A difficult airway (DA) is one in which there is a problem establishing or maintaining gas exchange via a mask, an artificial airway, or both. A wide range of pathologic conditions, including developmental malformations, inflammatory lesions, endocrine and metabolic disorders, infections, trauma, and structural problems (e.g., foreign body or intrinsic or extrinsic masses), occur in a large number of anatomic locations (head, neck, spine, face, oral cavity, larynx, subglottic region, trachea) and can cause a DA. Familiarity with disease states and common syndromes increases one’s ability to recognize a DA in children and will lead to appropriate preparation and management of the airway. The anomalies complicating airway management in pediatric patients can be categorized in different ways. In this article, the DA is classified according to the anatomic region of the airway affected. With certain disease states, the DA may be due to involvement of multiple anatomic structures. Table 1 lists conditions that may be associated with airway problems in pediatric patients. It is beyond the scope of this article to discuss each of these disease states, but some of them are detailed in other articles in this issue. Important references are added where possible.

Rapid Sequence Anesthesia Induction and Advanced Airway Management in Pediatric Patients

A rapid controlled induction of anesthesia is useful to facilitate emergency intubation and to reduce the complications of intubation in pediatric patients. A protocol for rapid sequence intubation and suggestions for optimizing airway management in the Emergency Department are described. The use of end tidal carbon dioxide monitoring and pulse oximetry are strongly advocated to monitor all intubations in the Emergency Department.