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Anesthesia pediatric airway

Martin Krebs, Lutz Müller-Lobeck, Roland C E Francis
Airway management is a major competence of clinical anesthesia. Knowledge of available materials and skills in the use of specific methods and techniques are essential and should be trained routinely. In 2011 the scientific working group in pediatric anesthesia (WAKKA) of the German Society for anesthesia and intensive care medicine (DGAI) published a treatment recommendation for the management of the unexpected difficult pediatric airway. Furthermore, a recommendation for the management of the expected difficult pediatric airway is currently being compiled and the draft is available on the WAKKA homepage...
November 2018: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
Eunsun So, Hye Joo Yun, Myong-Hwan Karm, Hyun Jeong Kim, Kwang-Suk Seo, Hyunbin Ha
Oronasal fistulae (ONF) could remain after surgery in some patients with cleft palate. ONF ultimately requires intraoral surgery, which may lead to perioperative airway obstruction. Tongue flap surgery is a technique used to repair ONF. During the second surgery for performing tongue flap division, the flap transplanted from the tongue dorsum to the palate of the patient acts as an obstacle to airway management, which poses a great challenge for anesthesiologists. In particular, anesthesiologists may face difficulty in airway evaluation and patient cooperation during general anesthesia for tongue flap division surgery in pediatric patients...
October 2018: Journal of Dental Anesthesia and Pain Medicine
Chang-Hoon Koo, Sun Young Lee, Seung Hyun Chung, Jung-Hee Ryu
The purpose of this study was to compare the incidence of airway complications between extubation under deep anesthesia (deep extubation) and extubation when fully awake (awake extubation) in pediatric patients after general anesthesia. A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) statement standards. The review protocol was registered with the International Prospective Register of Systematic Reviews (registration number: CRD 42018090172)...
October 14, 2018: Journal of Clinical Medicine
Nicholas J Scalzitti, Kathleen M Sarber
Sleep-disordered breathing has a prevalence of 12% in the pediatric population. It represents a spectrum of disorders encompassing abnormalities of the upper airway that lead to sleep disruption, including primary snoring, obstructive sleep apnea, central sleep apnea, and sleep-related hypoventilation. Sleep-disordered breathing is the most common indication for adenotonsillectomy, one of the most common procedures performed in children. In recent years, the American Academy of Otolaryngology-Head and Neck Surgery, American Academy of Pediatrics, and the American Society of Anesthesiologists have crafted guidelines to help safely manage children with sleep-disordered breathing...
November 2018: Paediatric Anaesthesia
Michael R King, Christine L Mai, Paul G Firth
The career of Dr Nishan Goudsouzian spanned half a century of pediatric anesthesia. His 50 years saw seminal contributions to the use of neuromuscular blocking agents in children, the development of proton beam therapy and magnetic resonance imaging for pediatric cancer, the introduction of the laryngeal mask airway, an explosion in the volume and depth of knowledge about pediatric anesthesia, the expansion of formal training in pediatric anesthesia, and the widening of academic efforts to improve anesthetic care for children worldwide...
November 2018: Paediatric Anaesthesia
Cristina Manera Dorneles, Gabriel Sartori Pacini, Matheus Zanon, Stephan Altmayer, Guilherme Watte, Marcelo C Barros, Edson Marchiori, Matteo Baldisserotto, Bruno Hochhegger
OBJECTIVE: To evaluate the feasibility of using ultra-low-dose computed tomography of the chest with iterative reconstruction without anesthesia for assessment of pulmonary diseases in children. METHODS: This prospective study enrolled 86 consecutive pediatric patients (ranging from 1 month to 18 years) that underwent ultra-low-dose computed tomography due to suspicion of pulmonary diseases, without anesthesia and contrast. Parameters used were: 80kVp; 15-30mA; acquisition time, 0...
September 17, 2018: Jornal de Pediatria
Nathaniel H Greene, Edmund H Jooste, Dylan P Thibault, Amelia S Wallace, Alice Wang, David F Vener, Roland A Matsouaka, Marshall L Jacobs, Jeffrey P Jacobs, Kevin D Hill, Warwick A Ames
BACKGROUND: In adults undergoing cardiopulmonary bypass surgery, oral intubation is typically preferred over nasal intubation due to reduced risk of sinusitis and infection. In children, nasal intubation is more common and sometimes preferred due to perceived benefits of less postoperative sedation and a lower risk for accidental extubation. This study sought to describe the practice of nasal intubation in the pediatric population undergoing cardiopulmonary bypass surgery and assess the risks/benefits of a nasal route against an oral one...
September 5, 2018: Anesthesia and Analgesia
Jeong Eun Lee, Ji Hyo Kim, Si-Oh Kim
RATIONALE: When patients are intubated and treated with mechanical ventilation, the upper respiratory tract is bypassed by the flow of dry and cold air. To prevent disturbances of airway homeostasis, a heat and moisture exchanger filter (HMEF) has been applied to breathing circuit. PATIENT CONCERNS: A 4-month-old male infant was ventilated with the pediatric HMEF. We report the impact of ignoring the direct influence of a filter containing deadspace in pediatric mechanical ventilation...
August 2018: Medicine (Baltimore)
Mark C Kendall, Dominic V Pisano, Alexander D Cohen, Michelle Gorgone, Zachary L McCormick, Christopher J Malgieri
STUDY OBJECTIVE: To review research highlights of manuscripts published in 2017 that pertain to all aspects of the clinical practice of anesthesiology. DESIGN: Narrative review. SETTING: N/A. MATERIALS: The major themes addressed in this review include recent studies examining airway management, obstetrical and gynecological anesthesia, pediatric anesthesia, cardiac anesthesia, regional analgesia and pain management...
December 2018: Journal of Clinical Anesthesia
Milton Halyson Benevides de Freitas, Luciana Cavalcanti Lima, Tania Cursino de Menezes Couceiro, Maria Célia Ferreira da Costa, Márcio Handerson Benevides de Freitas
BACKGROUND AND OBJECTIVES: Conjoined twins are monozygotic twins physically joined at some part of the body. This is a rare phenomenon, estimated between 1:50,000 to 1:200,000 births. The objective of this report is to present the anesthetic management and the perioperative challenges for a separation surgery. CASE REPORT: Thoraco-omphalopagus twins were diagnosed by ultrasound and were followed by the fetal medicine team of the service. After 11hours of cesarean, the pediatric surgical team chose to separate the twins...
August 7, 2018: Revista Brasileira de Anestesiologia
Ana Lygia R de Carvalho, Roberto B Vital, Carlos C S de Lira, Igor B Magro, Patrícia T S Sato, Laís H N Lima, Leandro G Braz, Norma S P Módolo
There is an association between upper respiratory tract infection (URTI) and an increased incidence of perioperative respiratory adverse events (PRAEs), which is a major risk for morbidity during pediatric anesthesia. The aim of the present study was to compare the risk of PRAEs among different airway devices during anesthesia in children with a URTI. A systematic review according to the Cochrane Handbook and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted. Only randomized clinical trials evaluating anesthesia in children with a URTI and who were submitted to any of the airway devices were included...
October 2018: Anesthesia and Analgesia
Stephen C Haskins, Richelle Kruisselbrink, Jan Boublik, Christopher L Wu, Anahi Perlas
This article in our series on point-of-care ultrasound (US) for the regional anesthesiologist and pain management specialist describes the emerging role of gastric ultrasonography. Although gastric US is a relatively new point-of-care US application in the perioperative setting, its relevance for the regional anesthesiologist and pain specialist is significant as our clinical practice often involves providing deep sedation without a secured airway. Given that pulmonary aspiration is a well-known cause of perioperative morbidity and mortality, the ability to evaluate for NPO (nil per os) status and risk stratify patients scheduled for anesthesia is a powerful skill set...
October 2018: Regional Anesthesia and Pain Medicine
Jörg Thomas, Markus Weiss, Vincenzo Cannizzaro, Christian Peter Both, Alexander Robert Schmidt
BACKGROUND: Over the last decade, cuffed endotracheal tubes are increasingly used in pediatric anesthesia and also in pediatric intensive care. However, the smaller inner diameter of cuffed endotracheal tubes and, implicitly, the increased endotracheal tube resistance is still a matter of debate. AIMS: This in vitro study investigated work of breathing and inspiratory airway pressures in cuffed and uncuffed endotracheal tubes and the impact of pressure support ventilation and automatic tube compensation...
September 2018: Paediatric Anaesthesia
Harish Karanth, U S Raveendra, Rithesh B Shetty, Pramal Shetty, Padmini Thalanjeri
Background and Objectives: Endotracheal intubation is the most important and crucial step during administration of general anesthesia. It is more so in pediatric patients with associated deformities of cleft lip, palate, and alveolus. Propofol, an intravenous (i.v.) induction agent, has profound depressant effect on airway reflexes with a quick and smoother induction. Similarly, sevoflurane, an inhalational agent, has relatively pleasant smell, low airway irritability, and more cardiostable properties...
April 2018: Anesthesia, Essays and Researches
J Patrick Bowman, Michael P Nedley, Kimberly A Jenkins, Charles R Fahncke
The purpose of this article was to determine if pediatric dental treatment under general anesthesia utilizing orotracheal intubation takes longer than using nasotracheal intubation techniques. Twenty-six American Society of Anesthesiologists Physical Status Classification I and II pediatric dental patients, ages 2-8 years treated under general anesthesia, were assigned to 1 of 2 groups: (a) nasotracheal intubation (control, n = 13), (b) orotracheal intubation (experimental, n = 13). Times for intubation, radiographic imaging, and dental procedures, as well as total case time were quantified...
2018: Anesthesia Progress
Naomi-Liza Denning, Ibrahim Abd El-Shafy, John Hagen, Steven Stylianos, Jose M Prince, Aaron M Lipskar
BACKGROUND: The development of a gastrocutaneous fistula (GCF) after gastrostomy tube removal is a frequent complication that occurs 5%-45% of the time. Conservative therapy with chemical cauterization is frequently unsuccessful, and surgical GCF repair with open primary layered closure of the gastrotomy is often required. We describe an alternative approach of GCF closure that is an outpatient, less invasive procedure that allows patients to avoid the comorbidities of general endotracheal anesthesia and intraabdominal surgery...
September 2018: Journal of Surgical Research
Karin Becke, Christoph Eich, Claudia Höhne, Martin Jöhr, Andreas Machotta, Markus Schreiber, Robert Sümpelmann
Inspired by the Choosing Wisely initiative, a group of pediatric anesthesiologists representing the German Working Group on Paediatric Anaesthesia (WAKKA) coined and agreed upon 10 concise positive ("dos") or negative ("don'ts") evidence-based recommendations. (i) In infants and children with robust indications for surgical, interventional, or diagnostic procedures, anesthesia or sedation should not be avoided or delayed due to the potential neurotoxicity associated with the exposure to anesthetics...
July 2018: Paediatric Anaesthesia
Bin Zhang, Harshad G Gurnaney, Paul A Stricker, Jorge A Galvez, Rebecca S Isserman, John E Fiadjoe
BACKGROUND: The GlideScope Cobalt is one of the most commonly used videolaryngoscopes in pediatric anesthesia. Although visualization of the airway may be superior to direct laryngoscopy, users need to learn a new indirect way to insert the tracheal tube. Learning this indirect approach requires focused practice and instruction. Identifying the specific points during tube placement, during which clinicians struggle, would help with targeted education. We conducted this prospective observational study to determine the incidence and location of technical difficulties using the GlideScope, the success rates of various corrective maneuvers used, and the impact of technical difficulty on success rate...
August 2018: Anesthesia and Analgesia
Jacob E Kuperstock, J Pieter Noordzij
OBJECTIVE: Upper aero-digestive tract foreign body management can be complicated and life threatening in both adult and pediatric populations. The variation seen with foreign bodies including shape, material, and duration of ingestion can impact clinical decision making and management. The objective of this report is to demonstrate a complicated case of upper airway obstruction by a plastic fork. METHOD: This case report presents an adult with ingestion of an intact plastic fork with acute laryngeal and cervical esophageal obstruction...
July 2018: American Journal of Otolaryngology
Ruiqiang Sun, Guolin Wang, Xuesong Gao, Shuzhen Wang
Despite its benignity, upper respiratory infections (URIs) 1 increase the risk of postoperative respiratory complications during the perioperative and postoperative periods. Flumazenil could improve the symptoms of respiratory obstruction.To evaluate the effect of flumazenil on the occurrence of respiratory complications during anesthesia emergence of children with preoperative URI.This was a prospective study of 164 consecutive pediatric patients who underwent strabismus surgery under general anesthesia at the Tianjin Eye Hospital between August 2016 and April 2017...
April 2018: Medicine (Baltimore)
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