Children form a specific group of patients, as there are significant differences between children and adults in both anatomy and physiology. Difficult airway may be unanticipated or anticipated. Difficulties encountered during intubation may cause hypoxia, hypoxic brain injury and, in extreme situations, may result in the patient’s death. There are few paediatric difficult-airway guidelines available in the current literature, and some of these have significant limitations. This position paper, intended for unanticipated difficult airway, was elaborated by the panel of specialists representing the Polish Society of Anaesthesiology and Intensive Care as well as the Polish Neonatal Society. It covers both elective intubation and emergency situations in children in all age groups. An integral part of the paper is an algorithm. The paper describes in detail all stages of the algorithm considering some modification in specific age groups, i.e. neonates.
Airway management in patients with suspected cervical spine injury plays an important role in the pathway of care of trauma patients. The aim of this study was to evaluate three different airway devices during intubation of a patient with reduced cervical spine mobility. Forty students of the third year of emergency medicine studies participated in the study (F = 26, M = 14). The time required to obtain a view of the entry to the larynx and successful ventilation time were recorded. Cormack-Lehane laryngoscopic view and damage to the incisors were also assessed. All three airway devices were used by each student (a novice) and they were randomly chosen. The mean time required to obtain the entry-to-the-larynx view was the shortest for the Macintosh laryngoscope 13.4 s (±2.14). Truview Evo2 had the shortest successful ventilation time 35.7 s (±9.27). The best view of the entry to the larynx was obtained by the Totaltrack VLM device. The Truview Evo2 and Totaltrack VLM may be an alternative to the classic Macintosh laryngoscope for intubation of trauma patients with suspected injury to the cervical spine. The use of new devices enables achieving better laryngoscopic view as well as minimising incisor damage during intubation.
Tracheal intubation may be defined as an artificial airway established in order to provide mechanical ventilation of the lungs during surgical procedures under general anaesthesia,
Excessive pressures exerted on the tongue during intubation may be associated with serious complications and may make intubation more difficult. The aim of this study was to evaluate five different intubating devices in the hands of experienced anaesthetists during simulated conditions of reduced cervical spine mobility. Forty senior anaesthetists participated in the study (female = 18, male = 22). The mean pressure exerted on the tongue during intubation was recorded with a standard manometer. The overall intubation success rate as well as the difference in exerted pressures between female and male anaesthetists were also assessed. The five studied devices were used by each participant and they were randomly chosen. Each anaesthetists participating in the study had over 15 years of clinical anaesthetic practice. The mean pressure exerted on the tongue during intubation was significantly lower when the videolaryngoscopes (VLs) were used (p < 0.0001 for each of the studied VL). There were failed intubation attempts with all of the studied devices, the highest failure rate was in the Airtraq® group, 10 in 40 (25%). Female anaesthetists exerted lower pressures during intubation with all studied devices (except the Airtraq®). However, the difference was only significant for the Macintosh laryngoscope (p = 0.0083). The blades of VLs exerted lower pressures on the tongue during intubation than the Macintosh laryngoscope blade. Their use may be associated with less complications. Furthermore, male anaesthetists exerted higher pressures on the soft tissues although this was neither statistically nor clinically significant. There was higher failed intubation rate in the male anaesthetist group.
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