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pediatric airway management

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https://www.readbyqxmd.com/read/29652686/massive-macroglossia-after-posterior-cranial-fossa-surgery-a-case-report
#1
Jennifer F Ha, Lisa N Vitale, Marie A Pfarr, Yu Kawai, David A Zopf
A 16-year-old boy with Chiari 1 malformation presented for an elective suboccipital craniectomy and C1 laminectomy. His intraoperative course was uneventful. At the conclusion of the procedure, he met extubation criteria and followed commands. After extubation, he developed progressive upper airway obstruction and became obtunded. He was reintubated via videolaryngoscopy, which showed edema not only to the tongue, but also to the posterior pharynx and blisters over the vocal folds and epiglottis. The patient was transferred to the pediatric intensive care unit intubated and sedated...
April 15, 2018: A&A practice
https://www.readbyqxmd.com/read/29643628/pediatric-critical-incidents-reported-over-15-years-at-a-tertiary-care-teaching-hospital-of-a-developing-country
#2
Shemila Abbasi, Fauzia Anis Khan, Sobia Khan
Background and Aims: The role of critical incident (CI) reporting is well established in improving patient safety but only a limited number of available reports relate to pediatric incidents. Our aim was to analyze the reported CIs specific to pediatric patients in our database and to reevaluate the value of this program in addressing issues in pediatric anesthesia practice. Material and Methods: Incidents related to pediatric population from neonatal period till the age of 12 years were selected...
January 2018: Journal of Anaesthesiology, Clinical Pharmacology
https://www.readbyqxmd.com/read/29628599/temporomandibular-joint-ankylosis-a-pediatric-difficult-airway-management
#3
Anoop Sharma, Deepak Dwivedi, Ram Murti Sharma
Intubating a pediatric patient with temporomandibular joint ankylosis is a daunting task, and it becomes more challenging with limited mouth opening. Fiberoptic nasotracheal intubation technique is considered a gold standard. We describe an improvised technique of securing airway in the absence of appropriate-sized fiberoptic scope. The endotracheal tube inserted in the left nostril for maintaining depth of anesthesia was advanced under vision by the fiberoptic scope inserted into the right nostril, and with external laryngeal manipulation, the airway was secured with no complications...
January 2018: Anesthesia, Essays and Researches
https://www.readbyqxmd.com/read/29625664/challenges-in-the-treatment-of-asthma-in-children-and-adolescents
#4
REVIEW
Stanley J Szefler, Bradley Chipps
OBJECTIVE: Despite the availability of effective treatments, asthma control in children and adolescents remains inadequate and rates of health care use are high. This follow-up to a recent review (O'Byrne et al, Eur Respir J. 2017;50[3]) examines a number of challenges in current pediatric asthma management compared with that of an adult perspective and discusses possible alternative strategies that might improve pediatric asthma management and control. DATA SOURCES: The evidence base for this review is limited because, historically, much of the research has been performed in adults...
April 2018: Annals of Allergy, Asthma & Immunology
https://www.readbyqxmd.com/read/29622333/emergency-care-of-pediatric-burns
#5
REVIEW
Ashley M Strobel, Ryan Fey
Although the overall incidence of and mortality rate associated with burn injury have decreased in recent decades, burns remain a significant source of morbidity and mortality in children. Children with major burns require emergent resuscitation. Resuscitation is similar to that for adults, including pain control, airway management, and administration of intravenous fluid. However, in pediatrics, fluid resuscitation is needed for burns greater than or equal to 15% of total body surface area (TBSA) compared with burns greater than or equal to 20% TBSA for adults...
May 2018: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/29622331/postoperative-tonsillectomy-hemorrhage
#6
REVIEW
Jessica J Wall, Khoon-Yen Tay
Post-tonsillectomy hemorrhage represents a potentially life-threatening condition that occurs in up to 5% of pediatric patients. Minor bleeding often precedes severe hemorrhage. Patients with minor or self-resolving bleeding should be observed in the emergency department or admitted for monitoring. Patients with severe bleeding should be immediately assessed for airway and hemodynamic stability. Management of severe bleeding includes immediate surgical consultation or initiation of the transfer process to a center with surgical capabilities, direct pressure to the site of hemorrhage with or without the additional of a hemostatic agent, possible rapid sequence intubation, and management of hemodynamic instability with volume resuscitation...
May 2018: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/29622330/pediatric-ventilator-management-in-the-emergency-department
#7
REVIEW
Garrett S Pacheco, Jenny Mendelson, Mary Gaspers
Pediatric mechanical ventilation is first initiated by emergency physicians when performing active airway management in a critically ill or injured child. When initiating and adjusting mechanical ventilation, the child has unique anatomy and physiology to consider. The EP is the first to respond to ventilator alarm triggers, and the initial medical provider to resuscitate the ventilated pediatric patient who is deteriorating while in the emergency department. This article uses cases to provide a framework to initiate and troubleshoot mechanical ventilation of pediatric patients in the emergency department...
May 2018: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/29622320/laryngomalacia-tracheomalacia-and-bronchomalacia
#8
Erik B Hysinger
Airway malacia can occur in the larynx (larygomalacia), trachea (tracheomalacia), or bronchi (bronchomalacia). As a group these are the most common congenital abnormalities of the pediatric airway and are characterized by increased airway compliance, resulting in excessive dynamic collapse during the respiratory cycle. While a diagnosis can be suspected based on clinical history and physical examination, definitive evaluation is based of nasopharyngolaryngoscopy and/or bronchoscopy. Observation and conservative management are typically all that are required...
April 3, 2018: Current Problems in Pediatric and Adolescent Health Care
https://www.readbyqxmd.com/read/29619557/performance-and-skill-retention-of-five-supraglottic-airway-devices-for-the-pediatric-difficult-airway-in-a-manikin
#9
Johannes Kulnig, Lisa Füreder, Nicole Harrison, Michael Frass, Oliver Robak
Supraglottic airway devices (SADs) have been introduced to assist medical professionals in emergency situations with limited experience in securing airways via conventional endotracheal intubation (ETI). Literature on the use of SADs for securing an airway during pediatric critical settings is scarce, and there is a lack of studies comparing different SADs to each other and to conventional ETI. We conducted a study comparing five different SADs to ETI with regard to success rate, time to first ventilation, and personal rating in a pediatric manikin under simulated physiologic and pathologic airway conditions in 41 pediatricians of varying clinical experience and training...
April 5, 2018: European Journal of Pediatrics
https://www.readbyqxmd.com/read/29613935/the-use-of-emergency-physicians-to-deliver-anesthesia-for-orthopaedic-surgery-in-austere-environments-the-expansion-of-the-emergency-physician-s-general-anesthesia-syllabus-to-orthopaedic-surgery
#10
Ogedad Pierre, John F Lovejoy, Robert Stanton, Richard Skupski, Harold Previl, Jerry Bernard, Lia Losonczy, Mark Walsh
BACKGROUND: Five billion people, primarily in low-income and middle-income countries, cannot access safe, affordable surgical and anesthesia care, particularly for orthopaedic trauma. The rate-limiting step for many orthopaedic surgical procedures performed in the developing world is the absence of safe anesthesia. Even surgical mission teams providing surgical care are limited by the availability of anesthesiologists. Emergency physicians, who are already knowledgeable in airway management and procedural sedation, may be able to help to fulfill the need for anesthetists in disaster relief and surgical missions...
April 4, 2018: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/29609717/sleep-disorders-and-their-management-in-children-with-ehlers-danlos-syndrome-referred-to-sleep-clinics
#11
Keren Armoni Domany, Sumalee Hantragool, David F Smith, Yuanfang Xu, Monir Hossain, Narong Simakajornboon
STUDY OBJECTIVES: The nature of sleep disorders in children with Ehlers-Danlos syndrome (EDS) is unknown. We aimed to describe the type, the management, and the short-term outcome of sleep disorders in children with EDS referred to sleep clinics. METHODS: This is a retrospective review of medical records and polysomnography tests of children with EDS younger than 18 years who were referred to the sleep clinic. Demographic information and medical history were collected, and polysomnography tests were reviewed...
March 30, 2018: Journal of Clinical Sleep Medicine: JCSM: Official Publication of the American Academy of Sleep Medicine
https://www.readbyqxmd.com/read/29605364/management-of-complex-pediatric-laryngotracheal-stenosis-with-skin-graft-reconstruction
#12
Sarah N Bowe, Carissa J Wentland, G S Sandhu, Christopher J Hartnick
OBJECTIVES: For pediatric patients with laryngotracheal stenosis, the ultimate goal is creation of a safe, functional airway. Unfortunately, wound healing in a hollow structure can complicate repair attempts, leading to restenosis. Herein, we present our experience using skin-grafting techniques in two complex pediatric laryngotracheal stenosis cases, leading to successful decannulation or speech production. METHODS: A chart review was performed examining the evaluation and management of two pediatric patients with laryngotracheal stenosis despite prior reconstructive attempts...
May 2018: International Journal of Pediatric Otorhinolaryngology
https://www.readbyqxmd.com/read/29602216/transoral-resection-of-extensive-pediatric-supraglottic-neurofibroma
#13
Mark A Arnold, Anthony J Mortelliti, Mark F Marzouk
This case report describes the novel use of transoral robotic surgery (TORS) with delayed transoral laser microsurgery (TLM) for residual disease in the resection of a pediatric neurofibroma with supraglottic and parapharyngeal space extension. Postoperatively, the patient had excellent functional outcomes. This case demonstrates that pediatric TORS is feasible, safe, and complementary to TLM. Neurofibroma is just one of the diverse pathologic processes of the pediatric airway that can be managed via transoral surgery, and applications of TORS with TLM will continue to broaden as our experience develops...
March 30, 2018: Laryngoscope
https://www.readbyqxmd.com/read/29575399/unique-application-of-awake-tracheoscopy-and-endobronchial-ultrasound-in-the-management-of-tracheal-mucoepidermoid-carcinoma
#14
Saad Rehman, Harold N Lovvorn, Otis B Rickman, Christopher T Wootten, Sivakumar Chinnadurai
BACKGROUND: Mucoepidermoid carcinoma of the trachea is a rare pediatric malignancy that presents unique challenges in diagnosis, operative management, and surveillance. METHODS AND RESULTS: We present a 17-year-old girl with primary tracheal mucoepidermoid carcinoma presenting in acute respiratory distress due to near-total occlusion of the tracheal airway. An algorithmic approach to preoperative planning was developed to evaluate and remove the tumor endoscopically without compromising oxygenation...
March 25, 2018: Head & Neck
https://www.readbyqxmd.com/read/29571543/dysphagia-in-children
#15
Kimberly L Duffy
Speech-Language Pathologists (SLP) play an integral role in evaluating and treating pediatric patients with dysphagia related to aerodigestive disorders. Non-supportive anatomy, cardio-respiratory and medical status, state control, neurologic functioning, postural stability and control, gastrointestinal functioning, hunger and satiation, developmental abilities, oral-motor skills, oral/pharyngeal reflexes, airway protection and secretion management can create barriers to successful oral feeding. Swallowing is broken down into four phases and difficulties can occur during any phase or in combination with another phase of swallowing...
March 2018: Current Problems in Pediatric and Adolescent Health Care
https://www.readbyqxmd.com/read/29554066/an-algorithm-for-airway-management-in-patients-with-pierre-robin-sequence
#16
Katherine E Hicks, Kathleen R Billings, Chad A Purnell, John M Carter, Bharat Bhushan, Arun K Gosain, Dana M Thompson, Jeffrey C Rastatter
PURPOSE: Airway management in neonates with Pierre Robin sequence (PRS) can be challenging. The goal was to describe the algorithm developed by the authors over the past 8 years. METHODS: A retrospective case series analyzing airway management in neonates with PRS admitted to the neonatal intensive care unit at a tertiary care pediatric hospital was performed. The utility of the proposed algorithm for airway management incorporating more consistent use of polysomnography (PSG), and airway assessment was assessed...
March 16, 2018: Journal of Craniofacial Surgery
https://www.readbyqxmd.com/read/29551475/first-line-treatment-using-high-flow-nasal-cannula-for-children-with-severe-bronchiolitis-applicability-and-risk-factors-for-failure
#17
C Guillot, C Le Reun, H Behal, J Labreuche, M Recher, A Duhamel, S Leteurtre
BACKGROUND: Viral bronchiolitis is the leading cause of hospitalization in children during the first 12 months of life. There is evidence to support the use of noninvasive ventilation in bronchiolitis. A recent respiratory management of bronchiolitis is the use of high-flow nasal cannula (HFNC) therapy. The primary objective of this study was to evaluate the use of HFNC as the first-line treatment for children with severe bronchiolitis and the secondary objective was to identify factors for HFNC therapy failure...
April 2018: Archives de Pédiatrie: Organe Officiel de la Sociéte Française de Pédiatrie
https://www.readbyqxmd.com/read/29549701/assessment-of-small-airway-function-and-reversibility-in-symptom-controlled-asthma-in-pediatric-patients
#18
Rattapon Uppala, Prapapan Kaenpugdee, Sureeporn Srisutthikamol, Jamaree Teeratakulpisarn
BACKGROUND: The goals of asthma management aim to control the symptoms and minimize future risk. There is, however, an option to stop controller medication if the patient has been well-controlled for at least 6-12 months. To assess control, both clinical symptom assessment and lung function should be monitored periodically. In practical clinical practice of pediatric patients, lung function is not available at all health centers. OBJECTIVES: to determine lung function with a focus on small airway function and the risk of reversibility among children who have been symptom-controlled...
March 12, 2018: Asian Pacific Journal of Allergy and Immunology
https://www.readbyqxmd.com/read/29531447/comparative-study-between-noninvasive-continuous-positive-airway-pressure-and-hot-humidified-high-flow-nasal-cannulae-as-a-mode-of-respiratory-support-in-infants-with-acute-bronchiolitis-in-pediatric-intensive-care-unit-of-a-tertiary-care-hospital
#19
Mihir Sarkar, Rajasree Sinha, Satyabrata Roychowdhoury, Sobhanman Mukhopadhyay, Pramit Ghosh, Kalpana Dutta, Shibarjun Ghosh
Background: Early initiation of appropriate noninvasive respiratory support is utmost important intervention to avoid mechanical ventilation in severe bronchiolitis. Aim: This study aims to compare noninvasive continuous positive airway pressure (nCPAP) and hot humidified high-flow nasal cannulae (HHHFNC) as modes of respiratory support in infants with severe bronchiolitis. Methods: Prospective, randomized, open-label pilot study done in a tertiary-care hospital Pediatric Intensive Care Unit (PICU)...
February 2018: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/29510872/decision-making-criteria-for-observational-management-of-congenital-pulmonary-airway-malformations-cpams
#20
Ashley Robinson, Rodrigo Romao, Jessica Mills, Dafydd A Davies
PURPOSE: The purpose of this study was to determine practice patterns of Canadian surgeons managing congenital pulmonary airway malformations (CPAMs) and factors influencing practice. METHODS: Pediatric surgeons in Canada were surveyed regarding their experience, evaluation, and management CPAMs, and what factors they feel qualify patients for observation vs resection. Data were summarized, and Fisher's-Exact and Kruskal-Wallis Tests applied where appropriate. RESULTS: Sixty eight percent (n=46) of surgeons responded...
February 10, 2018: Journal of Pediatric Surgery
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