A child with a difficult airway

Engelhardt, Thomas; Weiß, Markus

doi:10.1097/aco.0b013e3283532ac4

Cited by 74 publications

(65 citation statements)

References 35 publications

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“…3,4 Advantages of using an SGA for this purpose include the ability to overcome upper airway obstruction 5,6 and provision of a hands-free airway 7 with a relatively straightforward path to the larynx. For these reasons, SGA-guided intubations are preferred by many pediatric anesthesiologists for the management of the difficult pediatric airway.…”

Section: Résumémentioning

confidence: 99%

A randomized comparison between the i-gel™ and the air-Q™ supraglottic airways when used by anesthesiology trainees as conduits for tracheal intubation in children

Jagannathan

Sohn

Ramsey

et al. 2014

Can J Anesth/J Can Anesth

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Purpose Supraglottic airways are commonly used as conduits for fibreoptic bronchoscopy (FOB)-guided intubation in pediatric patients. We hypothesized that anesthesiology trainees with limited prior experience with FOB-guided intubation through a supraglottic airway in children would intubate the trachea faster through the air-Q TM supraglottic airway than through the i-gel TM . Methods Ninety-six children aged one month to six years were randomized to receive either the i-gel or air-Q for FOB-guided tracheal intubation by anesthesiology trainees. Time for successful tracheal intubation was the primary endpoint. Secondary endpoints included: time for device insertion, number of attempts for successful device insertion, airway leak pressures, FOB grade of laryngeal view, total number of attempts for tracheal intubation, time for removal of the device after tracheal intubation, and associated complications. Results The median (interquartile range [IQR]) times to successful tracheal intubation for the air-Q (62.5 [47.9-77] sec) and the i-gel (55.9 [48.5-81.8] sec) were not significantly different (median difference 6.6 sec; 95% confidence interval [CI] -13.3 to 8.7; P = 0.53). The median (IQR) time to insertion for the air-Q (16.7 [14.4-20.0] sec) was shorter than for the i-gel (19.6 [16.7-23.0] sec) (median difference 2.9 sec; 95% CI 0.8 to 4.7; P = 0.005). There were no differences between devices with respect to airway leak pressures, success rates, and time to removal. Compared with the air-Q, the i-gel was associated with more problems during device removal after tracheal intubation, including breakage of the tracheal tube pilot balloon (n = 0 vs n = 13, respectively; P \ 0.001), inadvertent extubation (n = 1 vs n = 5, respectively; P \ 0.001), and difficulty controlling the tracheal tube (n = 0 vs n = 21, respectively; P \ 0.001).Author contributions Narasimhan Jagannathan, Lisa Sohn, Andrea Huang, and Luis Sequera-Ramos participated in the conception and design of the study. Narasimhan Jagannathan, Lisa Sohn, Melissa Ramsey, Andrea Huang, Amod Sawardekar, and Loryn Kromrey participated in acquiring the data. Narasimhan Jagannathan, Andrea Huang, and Gildasio S. De Oliveira participated in the analysis of the data. Narasimhan Jagannathan, Lisa Sohn, Andrea Huang, and Gildasio S. De Oliveira participated in the interpretation of the data. Narasimhan Jagannathan, Lisa Sohn, Melissa Ramsey, Luis Sequera-Ramos, and Gildasio S. De Oliveira contributed to drafting the article. Conclusions Contrary to our hypothesis, both the air-Q and i-gel supraglottic airways served as effective conduits for FOB-guided tracheal intubation in children when performed by trainees with limited prior experience. The i-gel, however, was associated with more problems during device removal following tracheal intubation. This study was registered at http://clinicaltrials.gov/show/NCT02189590. RésuméObjectif Les voies aériennes supraglottiques sont fréquemment utilisées comme conduits pour l'intubation guidée par bronchoscopie à fi...

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Section: Résumémentioning

confidence: 99%

A randomized comparison between the i-gel™ and the air-Q™ supraglottic airways when used by anesthesiology trainees as conduits for tracheal intubation in children

Jagannathan

Sohn

Ramsey

et al. 2014

Can J Anesth/J Can Anesth

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“…Parmi les autres caractéristiques associées à une laryngoscopie difficile, citons une ouverture limitée de la bouche, une dentition proéminente, une asymétrie faciale accompagnée de déformations au niveau de l'oreille, et une fente palatine. 9 Prise en charge anesthésique Préparation Indépendamment de la méthode d'induction et de prise en charge des voies aériennes prévues, une bonne préparation du patient et de l'équipement est essentielle. Un chariot dédié aux voies aériennes difficiles devrait être à portée de main et inclure tout le matériel nécessaire, incluant plusieurs lames de laryngoscope, dispositifs supraglottiques, guides de sonde trachéale, canules oropharyngées, trompettes nasales ainsi que fibroscopes et vidéolaryngoscopes.…”

Section: Comment Prévoir Les Difficultés De Prise En Charge Des Voiesunclassified

“…Other features associated with difficult laryngoscopy include a limited mouth opening, prominent dentition, facial asymmetry with ear deformities, and a cleft palate. 9 …”

Section: Predicting Difficulty In Pediatric Airway Managementmentioning

confidence: 99%

Managing the challenging pediatric airway: Continuing Professional Development

Karsli

2015

Can J Anesth/J Can Anesth

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“…Difficult face mask ventilation in healthy children is very rare, 0.02% of total cases, and the case of impossible face mask ventilation probably does not exist 1 . The incidence of difficult intubation in healthy children under 16 years of age is 0.095%, with a higher incidence of 0.24% in children under 1 year of age 5 .…”

Section: The Role Of Lma In Difficult Pediatric Airwaymentioning

confidence: 99%

“…The presence of congenital or acquired airway problems in children increases the risk to the patient and nervousness of the anesthesiologist. Careful preoperative evaluation, training in recognizing challenges in pediatric airway, preparation airway trolleys adapted to local conditions, and accepted difficult airway algorithms simple and easy to memorize are essential for the management of airway in children 1 . LMA is a useful, powerful airway management device for routine pediatric airway management and pediatric emergency situations.…”

Section: Introductionmentioning

confidence: 99%

Simple, Timely, Safely? Laryngeal Mask and Pediatric Airway

Karišik

2016

ACC

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SuMMARY -Laryngeal mask airway (LMA) was a useful, powerful airway management device for routine pediatric airway management, pediatric difficult airway, and in pediatric emergency situations. Over years, various designs, induction and insertion techniques have been described. LMA provides ease of placement and removal as compared with endotracheal intubation, less traumatism for the respiratory tract, better tolerability by patients, improved hemodynamic stability during emergency, less coughing, less sore throat, avoidance of laryngoscopy, and hands free airway. On the other hand, LMA is not suitable to overcome functional airway problems and mechanical airway obstruction in children. Simple airway management in pediatric patients is normally easy in experienced hands, for anesthesiologists working in specialized hospitals with appropriate personnel and equipment that guarantee optimal safety in these patients. On the other hand, pediatric airway management is a great challenge for anesthesiologists working in departments with a small number of pediatric surgical procedures. Careful preoperative evaluation, preparation and training in the recognition of challenges in pediatric airway are essential for the management of the airway in children. LMA plays a special role in the management of difficult pediatric airway; as a supraglottic airway device, it is incorporated into difficult pediatric airway algorithms.

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A child with a difficult airway

Cited by 74 publications

References 35 publications

A randomized comparison between the i-gel™ and the air-Q™ supraglottic airways when used by anesthesiology trainees as conduits for tracheal intubation in children

A randomized comparison between the i-gel™ and the air-Q™ supraglottic airways when used by anesthesiology trainees as conduits for tracheal intubation in children

Managing the challenging pediatric airway: Continuing Professional Development

Simple, Timely, Safely? Laryngeal Mask and Pediatric Airway

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