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The difficult pediatric airway

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18 papers 100 to 500 followers
By Sean Fox Adult and Pediatric Emergency Medicine Physician, Associate Professor
Cengiz Karsli
PURPOSE: This module will give the anesthesia provider the information needed to identify, prepare for, and clinically manage a difficult airway in children. PRINCIPAL FINDINGS: Although the incidence of difficult intubation is lower in children than in adults, the anesthesiologist who even occasionally cares for children must be prepared to manage the pediatric patient with a known or suspected difficult airway. Many of the predictors of a difficult intubation that are useful in adults do not apply to children...
September 2015: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
Cengiz Karsli, Carolyne Pehora, Adel Al-Izzi, Preethy Mathew
No abstract text is available yet for this article.
June 2016: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
Joshua Belanger, Mark Kossick
The goal of this literature review is to provide the anesthesia practitioner with the skill set to detect and prepare for a difficult pediatric airway. The authors have reviewed and compiled information on some of the most common conditions that can predispose pediatric patients to a difficulty airway, such as macroglossia, mandibular hypoplasia, micrognathia, cervical instability, limited cervical movement, maxillary and midfacial hypoplasia, and cleft palate. This article provides an overview of preoperative assessment techniques, normal pediatric airway anatomy, and respiratory physiology...
February 2015: AANA Journal
Thomas Engelhardt, Markus Weiss
PURPOSE OF REVIEW: Difficulties in pediatric airway management are common and continue to result in significant morbidity and mortality. This review reports on current concepts in approaching a child with a difficult airway. RECENT FINDINGS: Routine airway management in healthy children with normal airways is simple in experienced hands. Mask ventilation (oxygenation) is always possible and tracheal intubation normally simple. However, transient hypoxia is common in these children usually due to unexpected anatomical and functional airway problems or failure to ventilate during rapid sequence induction...
June 2012: Current Opinion in Anaesthesiology
Edwardina M M A Lillie, Louise Harding, Mark Thomas
Difficult intubation of a 2.4 kg ex premature, suspected Pierre Robin Sequence with upper airway obstruction causing respiratory failure. Multiple failed intubation attempts by an experienced pediatric anesthetist using described techniques and adjuncts. A description of a simple new maneuvre using a GlideScope and a stylet. By twisting the stylet into a spiral shape, the endotracheal tube was given improved maneuverability that allowed the intubator to place the endotracheal tube tip to the glottis opening...
April 2015: Paediatric Anaesthesia
Paul W Sheeran, Brian K Walsh, Andre M Finley, Aleta K Martin, Amy C Brenski
BACKGROUND: Appropriate recognition and management of the pediatric difficult airway is essential. Two patient deaths in a 2-year period involving children with a known difficult airway led to the formation of the institution's multidisciplinary Difficult Airway Committee. METHODS: Patients with a suspected difficult airway or a known difficult airway are entered into a registry of difficult airway patients. A note describing the airway and any experiences at airway manipulation is entered as part of a difficult airway note in the patient's electronic medical record as soon as the patient is recognized as having a difficult airway...
August 2014: Paediatric Anaesthesia
Ann E Black, Paul E R Flynn, Helen L Smith, Mark L Thomas, Kathy A Wilkinson
BACKGROUND: Most airway problems in children are identified in advance; however, unanticipated difficulties can arise and may result in serious complications. Training for these sporadic events can be difficult. We identified the need for a structured guideline to improve clinical decision making in the acute situation and also to provide a guide for teaching. OBJECTIVE: Guidelines for airway management in adults are widely used; however, none have been previously devised for national use in children...
April 2015: Paediatric Anaesthesia
Arnim Vlatten, Sylvie Aucoin, Sharon Litz, Brian MacManus, Chris Soder
INTRODUCTION: Difficult airway management in children is challenging. One alternative device to the gold standard of direct laryngoscopy is the STORZ Bonfils fiberscope (Karl Storz Endoscopy, Tuttlingen, Germany), a rigid fiberoptic stylette-like scope with a curved tip. Although results in adults have been encouraging, reports regarding its use in children have been conflicting. We compared the effectiveness of a standard laryngoscope to the Bonfils fiberscope in a simulated difficult infant airway...
June 2010: Paediatric Anaesthesia
Jost Kaufmann, Michael Laschat, Thomas Engelhardt, Martin Hellmich, Frank Wappler
BACKGROUND: Fiberoptic intubation (FOI) is the gold standard for the tracheal intubation in adults with a difficult airway. However, this technique is more difficult in the narrow pediatric airway and the evaluation of alternative devices in children remains desirable. The Bonfils fiberscope (BF) is well described for the difficult airway, but no clinical data assessing its use in the difficult pediatric airway are available. METHODS: A controlled clinical study was conducted comparing BF and FOI in children and infants requiring tracheal intubation with a suspected difficult airway or who demonstrated a difficult airway which was unanticipated...
April 2015: Paediatric Anaesthesia
Ana Lia Graciano, Robert Tamburro, Ann E Thompson, John Fiadjoe, Vinay M Nadkarni, Akira Nishisaki
PURPOSE: To evaluate the incidence and associated risk factors of difficult tracheal intubations (TI) in pediatric intensive care units (PICUs). METHODS: Using the National Emergency Airway Registry for Children (NEAR4KIDS), TI quality improvement data were prospectively collected for initial TIs in 15 PICUs from July 2010 to December 2011. Difficult pediatric TI was defined as TIs by direct laryngoscopy which failed or required more than two laryngoscopy attempts by fellow/attending-level physician providers...
November 2014: Intensive Care Medicine
Jannet J Lee-Jayaram, Loren G Yamamoto
Securing the pediatric airway in the emergency setting is an uncommon event that is complicated by anatomic, physiologic, and environmental factors. Even more uncommonly, practitioners are faced with the added complication of a difficult airway, and the question of what alternatives to traditional endotracheal intubation are available and most useful may arise. Timely and effective intervention determines the patient's clinical outcome. The purpose of this review was to detail specific alternative airway management strategies and tools for use in the pediatric emergency department...
March 2014: Pediatric Emergency Care
Joshua A Blatter, Jonathan D Finder
Patients with neuromuscular disorders undergoing general anesthesia present a special set of respiratory problems for perioperative management. While there are disease-specific concerns, there are many common themes in the respiratory management of patients with neuromuscular disorders. These problems are discussed in this review. Such common perioperative concerns include upper airway obstruction, chest wall restriction, postoperative hypoventilation, inadequate airway clearance, and chronic lower airway disease...
September 2013: Paediatric Anaesthesia
Rani A Sunder, Dawit T Haile, Patrick T Farrell, Anshuman Sharma
Management of a pediatric airway can be a challenge, especially for the non-pediatric anesthesiologists. Structured algorithms for an unexpected difficult pediatric airway have been missing so far. A recent step wise algorithm, based on the Difficult Airway society (DAS) adult protocol, is a step in the right direction. There have been some exciting advances in development of pediatric extra-glottic devices for maintaining ventilation, and introduction of pediatric versions of new 'non line of sight' laryngoscopes and optical stylets...
October 2012: Paediatric Anaesthesia
Bennett Barch, Jeffrey Rastatter, Narasimhan Jagannathan
OBJECTIVE: To evaluate the intubating laryngeal airway (ILA) in providing safe endotracheal intubation in pediatric patients with difficult airway; to describe a method for using flexible fiberoptic bronchoscopy with the ILA for evaluating the pediatric airway. METHODS: Case series with chart review of the medical records of patients who had the ILA and fiberoptic intubation used to secure the airway at a tertiary pediatric hospital from January 2009 to January 2011...
November 2012: International Journal of Pediatric Otorhinolaryngology
Craig Sims, Britta S von Ungern-Sternberg
Management of a child's airway is one of the main sources of stress for anesthetists who do not routinely anesthetize children. Unfortunately, trainees are gaining less experience in pediatric airway management than in the past, which is particularly difficult at a time when some beliefs about airway management are being challenged and airway management is less standardized. Fortunately, most children have an easily managed, normal airway. Nevertheless, it is of vital importance to teach our trainees the basic airway skills that are probably the most important skill in an anesthetists' repertoire when it comes to a difficult airway situation...
June 2012: Paediatric Anaesthesia
Michael R Hernandez, P Allan Klock, Adranik Ovassapian
The development of the laryngeal mask airway in 1981 was an important first step toward widespread use and acceptance of the extraglottic airway (EGA). The term extraglottic is used in this review to encompass those airways that do not violate the larynx, in addition to those with a supraglottic position. Although the term extraglottic may be broad and include airways such as tracheostomy tubes, the term supraglottic does not describe a large number of devices with subglottic components and is too narrow for a discussion of modern devices...
February 2012: Anesthesia and Analgesia
Rolf Holm-Knudsen
During the last decade, several new look-around-corner or video airway devices have proven useful in clinical adult practice. Only four of them are currently available in sizes that may be used in children younger than 2 years of age: the AIRTRAQ® Disposable Optical Laryngoscope (Prodol Meditec, Vizcaya, Spain), the GlideScope® Video Laryngoscope (Verathon, Bothell, WA, USA), the Storz DCI® Video Laryngoscope (Karl Storz, Tuttlingen, Germany), and the Truview PCD™ Infant (Truphatek, Netanya, Israel). Here, we review the literature and describe the clinical use of each device in this age-group...
February 2011: Paediatric Anaesthesia
Markus Weiss, Thomas Engelhardt
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...
May 2010: Paediatric Anaesthesia
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