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Nathan M Blair, Kristen G Berrebi, Deborah S Kacmarynski
This report focuses on the clinical course and treatment of an infant male who had a progressively enlarging tongue mass initially thought to be an infantile hemangioma but was later found to be an infantile fibrosarcoma. Treatment included surgical excision with anticipated difficult mask ventilation with active rhino/enterovirus infection bronchiolitis and recent croup. Complete surgical excision is the mainstay of treatment, and the patient did have negative margins after complete surgical re-excision. The patient has surveillance MRI scans and remains without fibrosarcoma recurrence...
November 2023: Curēus
#22
JOURNAL ARTICLE
Luciana Cavalcanti Lima, Débora de Oliveira Cumino, Alex Madeira Vieira, Cláudia Helena Ribeiro da Silva, Mariana Fontes Lima Neville, Felipe Oliveira Marques, Vinicius Caldeira Quintão, Ricardo Vieira Carlos, Ana Carla Giosa Fujita, Hugo Ítalo Melo Barros, Daniela Biachi Garcia, Cynthia Beatriz Tostes Ferreira, Guilherme Antonio Moreira de Barros, Norma Sueli Pinheiro Módolo
Difficult airway management in pediatrics during anesthesia represents a major challenge, requiring a careful approach, advanced technical expertise, and accurate protocols. The task force of the Brazilian Society of Anesthesiology (SBA) presents a report containing updated recommendations for the management of difficult airways in children and neonates. These recommendations have been developed based on the consensus of a panel of experts, with the objective of offering strategies to overcome challenges during airway management in pediatric patients...
2024: Brazilian Journal of Anesthesiology
#23
Dulce Pereira, João Lusquinhos, Patrícia Santos
Meningoencephalocele is a rare congenital midline defect of cranial bone fusion characterized by herniation of the brain and meninges through the skull. In addition to the challenges of managing a major neurosurgical procedure in a pediatric patient, airway management in this group of patients requires advanced skills, and a difficult airway should be anticipated from the start. Since awake intubation is not an option in most pediatric cases with airway anatomy abnormalities and maintaining an adequate seal with a pediatric face mask is often impossible, airway management in patients with these lesions is highly challenging...
November 2023: Curēus
#24
REVIEW
Preetha S Velu, Rohith R Kariveda, William J Palmer, Jessica R Levi
OBJECTIVES: To evaluate existing literature to understand the utility and safety of uvulopalatopharyngoplasty (UPPP) for treatment of pediatric obstructive sleep apnea (OSA). METHODS: A literature review was conducted by two authors to search for studies from the inception of two databases until March 1, 2023. Studies in which participants were under 18 years of age and underwent UPPP for OSA or upper airway obstruction were selected. Data on variables such as pre- and postoperative severity, efficacy, complications, and follow-up were collected from all studies...
January 2024: International Journal of Pediatric Otorhinolaryngology
#25
Rodrigo Ferreira, Margarida Telo, Joana Figueiredo
The pediatric difficult airway is a challenge for the anesthesiologist. In this article, we describe a case where ketamine and dexmedetomidine were used to approach a difficult airway in a five-month-old patient with a palatal teratoma. These two drugs have complementary effects, because of which they can be used to maintain ventilation without compromising airway reflexes and are suitable for the management of pediatric difficult airways.
December 2023: Curēus
#26
Claudia Lorente, Edgar Kiss, Galit Kastner, Vedanta Singh Dariya, Patrick Olomu, Peter Szmuk
The laryngeal mask airway (LMA) is recognized as a safe alternative to endotracheal intubation for short-term airway maintenance. In this case report we present the case of a term neonate with upper airway obstruction which was managed with a deflated LMA for 7 consecutive days. Despite previous reports of extended LMA use in neonates without complications, this patient experienced significant pharyngeal mucosal injury and edema, leading to difficulty with subsequent intubation attempts.
December 8, 2023: Paediatric Anaesthesia
#27
JOURNAL ARTICLE
Eric J Wilsterman, Marianne E Nellis, Josep Panisello, Awni Al-Subu, Ryan Breuer, Dai Kimura, Conrad Krawiec, Palen P Mallory, Sholeen Nett, Erin Owen, Simon J Parsons, Ronald C Sanders, Annery Garcia-Marcinkiewicz, Natalie Napolitano, Justine Shults, Vinay M Nadkarni, Akira Nishisaki
OBJECTIVES: Children with trisomy 21 often have anatomic and physiologic features that may complicate tracheal intubation (TI). TI in critically ill children with trisomy 21 is not well described. We hypothesize that in children with trisomy 21, TI is associated with greater odds of adverse airway outcomes (AAOs), including TI-associated events (TIAEs), and peri-intubation hypoxemia (defined as > 20% decrease in pulse oximetry saturation [Sp o2 ]). DESIGN: Retrospective database study using the National Emergency Airway Registry for Children (NEAR4KIDS)...
April 1, 2024: Pediatric Critical Care Medicine
#28
JOURNAL ARTICLE
Sai Liang, Ji Wang, Kai Song, Ming Yu, Zhengpeng Gong
RATIONALE: Idiopathic subglottic stenosis is a fibrotic condition of unknown origin that results in blockage of the central airway in the subglottic region. It is widely acknowledged that subglottic stenosis is a relatively uncommon structural anomaly that is difficult to operate on and cure due to its anatomical location. Inguinal hernias are well-established to be prevalent in infants and youngsters. We present a case of subglottic stenosis in a child complicated with an inguinal hernia (IH)...
November 17, 2023: Medicine (Baltimore)
#29
JOURNAL ARTICLE
Benjamin T Kopp, Sydney E Ross, Dinesh Bojja, Lokesh Guglani, Joshua D Chandler, Rabindra Tirouvanziam, Misty Thompson, James E Slaven, James F Chmiel, Christopher Siracusa, Don B Sanders
BACKGROUND: Detecting airway inflammation non-invasively in infants with cystic fibrosis (CF) is difficult. We hypothesized that markers of inflammation in CF [IL-1β, IL-6, IL-8, IL-10, IL-17A, neutrophil elastase (NE) and tumor necrosis factor (TNF-α)] could be measured in infants with CF from nasal fluid and would be elevated during viral infections or clinician-defined pulmonary exacerbations (PEx). METHODS: We collected nasal fluid, nasal swabs, and hair samples from 34 infants with CF during monthly clinic visits, sick visits, and hospitalizations...
November 15, 2023: Journal of Cystic Fibrosis: Official Journal of the European Cystic Fibrosis Society
#30
Rana Tamraz, Roman Austin, Ricardo Falcon, Tania Kraai, Richard Lock, Timothy R Petersen, Codruta Soneru
Anesthetic management of children with a post-tonsillectomy hemorrhage can be challenging. The patients may be anemic and hypovolemic and are at increased risk of having a difficult airway due to active bleeding, vomiting, and anatomical issues. A clot may also interfere with viewing the larynx, further exacerbating the difficulty of intubation. We describe a pediatric post-tonsillectomy hemorrhage case complicated by a large obstructing clot that was removed with Magill forceps after the airway was successfully secured with an endotracheal tube during rapid sequence induction...
October 2023: Curēus
#31
Shiwei Huang, Zhihao Wang, Yauwai Chan, Tao Jiang
BACKGROUND: Cystic hygroma is a congenital lymphatic malformation. It may present as a huge mass in the neck, jeopardizing airway patency and prolonging intubation time, resulting in hypoventilation and hypoxemia. We used a high-flow nasal cannula to decrease the risk of hypoxemia and provide anesthesiologists sufficient time to perform tracheal intubation in young infants. CASE PRESENTATION: A 33-day-old infant (height, 55 cm; weight, 5.05 kg) was diagnosed with macro-cystic hygroma of the right neck...
October 2023: Curēus
#32
JOURNAL ARTICLE
Thomas Riva, Simon Goerge, Alexander Fuchs, Robert Greif, Markus Huber, Andrea C Lusardi, Thomas Riedel, Francis F Ulmer, Nicola Disma
BACKGROUND: Rapid-sequence tracheotomy and scalpel-bougie tracheotomy are two published approaches for establishing emergency front-of-neck access in infants. It is unknown whether there is a difference in performance times and success rates between the two approaches. AIMS: The aim of this cross-over randomized control trial study was to investigate whether the two approaches were equivalent for establishing tracheal access in rabbit cadavers. The underlying hypothesis was that the time to achieve the tracheal access is the same with both techniques...
November 10, 2023: Paediatric Anaesthesia
#33
JOURNAL ARTICLE
Mitsumasa Okamoto, Shoka Kimura, Machiko Hotta, Yudai Tsuruno, Hiroaki Fukuzawa
BACKGROUND: Pleuropulmonary blastoma (PPB) is an extremely rare and malignant pediatric lung tumor. Purely cystic PPB has a more favorable prognosis than solid PPB, but may be difficult to distinguish from a certain type of "benign" congenital pulmonary airway malformation before and during surgery. The influence of tumor rupture on long life prognosis has not been clarified in detail. CASE PRESENTATION: A 5-month-old boy underwent emergency transfer from another hospital due to a left thoracic cystic lesion and left pneumothorax detected on chest radiography performed for persistent wheeze and cough...
November 6, 2023: Surgical Case Reports
#34
Abdul Jamil Rasooly, Sahar Noor, Saif Ullah, Abdul Tawab Baryali, Ahmed Maseh Haidary
BACKGROUND: Pig bronchus is rare and usually asymptomatic, but it may also cause significant respiratory symptoms such as recurrent pneumonia, chronic bronchitis, atelectasis, and difficult airway management in surgical and critical care patients. This study is aimed to examine a case of pig bronchus in which the patient presented with recurrent pneumonia in her early days of life. CASE REPORT: A case report is the study design utilized in this assessment of a 40-days-old girl from a consanguineous marriage, who presented with cough and difficulty breathing for approximately a month...
2023: Pediatric Health, Medicine and Therapeutics
#35
JOURNAL ARTICLE
Kelsey M Gladen, David Tellez, Natalie Napolitano, Lauren R Edwards, Ronald C Sanders, Taiki Kojima, Matthew P Malone, Justine Shults, Conrad Krawiec, Shashikanth Ambati, Riley McCarthy, Aline Branca, Lee A Polikoff, Philipp Jung, Simon J Parsons, Palen Mallory, Kavipriya Komeswaran, Christopher Page-Goertz, Megan C Toal, G Kris Bysani, Keith Meyer, Fabrizio Chiusolo, Lily B Glater-Welt, Awni Al-Subu, Katherine Biagas, Jan Hau Lee, Michael Miksa, John S Giuliano, Krista L Kierys, Andrea M Talukdar, Michelle DeRusso, Laurence Cucharme-Crevier, Michelle Adu-Arko, Asha Shenoi, Dai Kimura, Molly Flottman, Shantaveer Gangu, Ashley D Freeman, Mark D Piehl, G A Nuthall, Keiko M Tarquinio, Ilana Harwayne-Gidansky, Tatsuya Hasegawa, Erin S Rescoe, Ryan K Breuer, Mioko Kasagi, Vinay M Nadkarni, Akira Nishisaki
OBJECTIVES: Extremes of patient body mass index are associated with difficult intubation and increased morbidity in adults. We aimed to determine the association between being underweight or obese with adverse airway outcomes, including adverse tracheal intubation (TI)-associated events (TIAEs) and/or severe peri-intubation hypoxemia (pulse oximetry oxygen saturation < 80%) in critically ill children. DESIGN/SETTING: Retrospective cohort using the National Emergency Airway for Children registry dataset of 2013-2020...
November 1, 2023: Pediatric Critical Care Medicine
#36
JOURNAL ARTICLE
Danielle M Van Damme, Emily M McRae, Sharon Y Irving, Serena P Kelly, Keiko M Tarquinio, John S Giuliano, Michael D Ruppe, Krista L Kierys, Ryan K Breuer, Simon J Parsons, Palen P Mallory, Asha N Shenoi, Kelly A Swain, Lee A Polikoff, Anthony Lee, Michelle A Adu-Darko, Natalie Napolitano, Justine Shults, Akira Nishisaki, John W Berkenbosch
OBJECTIVES: To describe tracheal intubation (TI) practice by Advanced Practice Registered Nurses (APRNs) in North American PICUs, including rates of TI-associated events (TIAEs) from 2015 to 2019. DESIGN/SETTING: Retrospective study using the National Emergency Airway Registry for Children with all TIs performed in PICU and pediatric cardiac ICU between January 2015 and December 2019. The primary outcome was first attempt TI success rate. Secondary outcomes were TIAEs, severe TIAEs, and hypoxemia...
February 1, 2024: Pediatric Critical Care Medicine
#37
Androcles Lester, Matthew R Paluska, Ricardo Falcon, Timothy R Petersen, Anil K Shetty, Codruta Soneru
In this case report, we present a critical situation during an open calvarial reconstruction involving an 11-month-old infant. The patient experienced accidental extubation, requiring immediate intervention while in the prone position. Approximately two hours post-incision, ventilation became increasingly difficult due to a significant leak detected in the system. On closer inspection, it was observed that both the rubber tourniquet responsible for securing the anesthesia circuit and the tape that held the endotracheal tube in place had become loosened...
October 2023: Curēus
#38
Shintaro Akimaru, Toshiyuki Nakanishi, Tatsuya Hasegawa, Kazuya Sobue
Children with trisomy 18 have abnormal airway anatomy, making their airway management challenging. Only a few papers have comprehensively described and discussed the use of supraglottic airway devices in patients with trisomy 18. We present a case of a 20-month-old boy with trisomy 18 who was scheduled for open repair of the right inguinal hernia. He had micrognathia, a short neck, and an atrial septal defect but was in a clinically stable condition. A supraglottic airway device was inserted under general anesthesia...
September 2023: Curēus
#39
JOURNAL ARTICLE
Luke Burton, Jeremy Loberger, Mark Baker, Priya Prabhakaran, Vidit Bhargava
OBJECTIVES: Post-extubation stridor (PES) is difficult to predict before extubation. We therefore evaluated the potential diagnostic performance of pre-extubation laryngeal air column width difference (LACWD) measurement, as assessed by intensivist-performed point-of-care laryngeal ultrasound, in relation to clinically important PES. DESIGN: Prospective observational cohort study. SETTING: Single quaternary care PICU (July 19, 2021, to October 31, 2022)...
October 10, 2023: Pediatric Critical Care Medicine
#40
JOURNAL ARTICLE
Anil Kumar, Arvind Kumar, Alok K Bharti, Annu Choudhary, Mumtaz Hussain, Shashank Dhiraj
BACKGROUND: The incidence of unanticipated difficult airways is higher in pediatric age groups than in adults due to the different airway anatomy, difficulty in airway examination, and congenital malformations. Rocuronium bromide has a comparable onset time to succinylcholine at its proportionate dose. Hence, we compared rocuronium bromide with succinylcholine to assess intubating conditions and their side effects, if any. METHOD: A total of 200 pediatric patients of American Society of Anesthesiologists (ASA) grades I and II between one and 14 years of age of either sex posted for elective surgery were included in the study...
September 2023: Curēus
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