Airway management in pediatric anesthesia

Kliniken für Anästhesiologie und operative Intensivmedizin, Charitè-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin.
Der Anaesthesist (Impact Factor: 0.76). 08/2006; 55(7):809-19; quiz 820.
Source: PubMed


Airway management in newborns, infants, and children is a challenge to anesthesia practitioners due to the particular anatomic and physiological characteristics. The larynx is positioned more cephalad, the occiput is protuberant, and the neck is short, which makes a special position for anesthesia induction necessary. The high respiratory frequency due to high oxygen demand and carbon dioxide production has to be taken into consideration during manual as well as mechanical ventilation. Different devices are available for airway management. Simple mask ventilation can be improved by a Wendl tube. The classic laryngeal mask can be recommended as a safe airway device in many indications, specifically in children with an upper respiratory airway infection. If intubation is indicated, an optimal size and position of the endotracheal tube has to be provided. Fiberoptic endotracheal intubation is recommended if a difficult airway is known or anticipated due to a craniofacial syndrome.

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    ABSTRACT: Difficult airway management in children is a particular challenge for anesthesiologists and pediatricians. This study was designed to evaluate the performance of the recently developed pediatric versions of the Bonfils fiberscope for elective endotracheal intubation during routine surgical procedures. After approval by the institutional review board and written informed consent, 55 children (age 6 +/- 4 years) scheduled for elective minor surgical procedures were enrolled. Nineteen children received atropine before the intubation attempt, while in the remaining 36 children, no antisialogogue was used. For endotracheal tubes up to 3.5 mm internal diameter, a fiberscope with outer diameter (OD) 2 mm, and for larger endotracheal tubes, a fiberscope OD 3.5 mm was used. Time to intubation and failure rate were obtained. In the 36 children without and the 19 children with atropine pretreatment, the success rate for tracheal intubation on the first attempt was 69%/78% (25/15 patients). 4/3 patients and 2/0 patients were intubated after two and three attempts, respectively, and in 5/1 patients (14%/5%) intubation failed even after three attempts. Time to intubation was median 58/60 s, 25th-75th percentile 35-100/32-110 s, and range 14-377/18-360 s. In both groups, failed intubations were because of the secretions contaminating the optic aperture. High failure rate and increased intubation times suggest that the pediatric Bonfils fiberscope has significant drawbacks when used for intubation of normal pediatric airways.
    No preview · Article · Dec 2008 · Pediatric Anesthesia
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    ABSTRACT: Fibre optic-assisted tracheal intubation through the laryngeal mask airway is a simple and safe procedure for securing the airway in the paediatric patient with unexpected and known difficult tracheal intubation. Therefore, fibre optic-assisted tracheal intubation through the laryngeal mask airway represents a standard airway technique and must be part of clinical education and also regular training. However, the removal of the laryngeal mask airway over the tracheal tube is impaired by the short length of the tracheal tube, easily resulting in tube dislocation from the trachea. Among several techniques to overcome this problem, the Cook airway exchange catheter offers a reliable method not only for safe removal of the laryngeal mask over the tracheal tube but also for insertion of an adequate tracheal tube, particularly in paediatric patients. This is particularly important for cuffed tubes as the pilot balloon of the cuffed tube is too large to pass through laryngeal mask airway tubes size 2.5 and smaller. This presentation demonstrates fibre optic-assisted tracheal intubation through the laryngeal mask airway in children step-by-step and discusses its clinical implications. A list with compatible sizes of laryngeal mask airways, tracheal tubes and airway exchange catheters is also provided.
    No preview · Article · Aug 2009 · Der Anaesthesist
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    ABSTRACT: Children account for only a small percentage of pre-hospital emergency patients but are a special challenge for the treating physician. The Medline database was selectively searched for articles appearing up to June 2009. The authors added other important literature of which they were aware. The broad spectrum of diseases, the wide age range with the physiological and anatomical changes that occur in it, and the special psychological, emotional, and communicative features of children make pediatric emergencies a special challenge for emergency physicians. A mastery of basic emergency techniques including clinical evaluation of the child, establishment of venous access, airway management, resuscitation, and drug dosing is essential for the successful emergency treatment of children. We recommend classifying the common non-traumatic pediatric emergencies by four cardinal manifestations: respiratory distress, altered consciousness, seizure, and shock. Classifying these rare emergency situations in this way helps assure that their treatment will be goal-oriented and appropriate to the special needs of sick children.
    Full-text · Article · Nov 2009 · Deutsches Ärzteblatt International
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