A clinical prediction rule to identify difficult intubation in children with Robin sequence requiring mandibular distraction osteogenesis based on craniofacial CT measures

Mao, Zhifeng; Zhang, Na; Cui, Yingqiu

doi:10.1186/s12871-019-0889-1

Cited by 5 publications

(7 citation statements)

References 26 publications

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“…Due to the congenital craniofacial anomalies, airway management for general anesthesia or acute respiratory distress in uncorrected PRS patients can present significant challenges even for experienced anesthesiologists. Mao and colleagues reported difficult intubation in 57% of patient with PRS requiring mandibular distraction osteogenesis [ 3 ]. In a retrospective chart review including 51 infants with mandibular hypoplasia, Frawley and colleagues described an incidence of difficult intubation of even 71% [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

“…In addition, the severity of dental trauma was lower with the Glidescope 1 Core™ (p < 0.001, 0 [0-1] vs. 2[2][3], Glidescope 1 Core™ vs. Miller laryngoscope; p < 0.001, 0 [0-1] vs. 1[1][2], Glidescope 1 Core™ vs. C-MAC 1 Miller). The C-MAC 1 Miller caused less dental trauma (p < 0.001, 1[1][2] vs. 2[2][3], C-MAC 1 Miller vs. Miller laryngoscope) and improved the Cormack and Lehane grade (p < 0.05, 1[1][2] vs. 2[1][2], C-MAC 1 Miller vs. Miller laryngoscope) compared to the Miller laryngoscope when used by anesthetists with limited previous experience. Although post-hoc analysis revealed no significant differences in the number of intubation attempts and the overall success rate, the failure rate was 11.6% with the Glidescope1 Core™ and 7% with the Miller laryngoscope.…”

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confidence: 99%

“…In addition, the number of optimization maneuvers was lower when using the C-MAC 1 Miller compared to the Glidescope1 Core™ (p < 0.05, 0 [0-1] vs. 0 [0-1], C-MAC 1 Miller vs. Glidescope 1 Core™).Regarding the subjective values, the conventional Miller laryngoscope was considered the most stable of the three devices (p < 0.01, 0.9 [0-1.9] vs. 2 [0.1-3.1], Miller laryngoscope vs. Glidescope 1 Core™; p < 0.05, 0.9 [0-1.9] vs. 2 [0.9-2.9], Miller laryngoscope vs. C-MAC 1 Miller). However, the Glidescope 1 Core™ and the C-MAC 1 Miller enabled a significantly better view (p < 0.001, 0.9 [0-1.1] vs. 4[2][3][4][5][6], Glidescope 1 Core™ vs. Miller laryngoscope; p < 0.001, 2[1][2][3] vs. 4[2][3][4][5][6], C-MAC 1 Miller vs. Miller laryngoscope) and required less force during tracheal intubation (p < 0.001, 1.8[1][2][3] vs. 4 [3-6.9], Glidescope 1 Core™ vs. Miller laryngoscope; p < 0.01, 2.9 [1.1-4.9] vs. 4 [3-6.9], C-MAC 1 Miller vs. Miller laryngoscope) compared to the conventional Miller laryngoscope. The Glidescope 1 Core™ offered the best view (p < 0.01, 0.9 [0-1.1] vs. 2[1][2][3], Glidescope 1 Core™ vs. C-MAC 1 Miller) and required the least amount of force during tracheal intubation (p < 0.05, 1.8[1][2][3] vs. 2.9 [1.1-4.9], Glidescope…”

mentioning

confidence: 99%

“…However, the Glidescope 1 Core™ and the C-MAC 1 Miller enabled a significantly better view (p < 0.001, 0.9 [0-1.1] vs. 4[2][3][4][5][6], Glidescope 1 Core™ vs. Miller laryngoscope; p < 0.001, 2[1][2][3] vs. 4[2][3][4][5][6], C-MAC 1 Miller vs. Miller laryngoscope) and required less force during tracheal intubation (p < 0.001, 1.8[1][2][3] vs. 4 [3-6.9], Glidescope 1 Core™ vs. Miller laryngoscope; p < 0.01, 2.9 [1.1-4.9] vs. 4 [3-6.9], C-MAC 1 Miller vs. Miller laryngoscope) compared to the conventional Miller laryngoscope. The Glidescope 1 Core™ offered the best view (p < 0.01, 0.9 [0-1.1] vs. 2[1][2][3], Glidescope 1 Core™ vs. C-MAC 1 Miller) and required the least amount of force during tracheal intubation (p < 0.05, 1.8[1][2][3] vs. 2.9 [1.1-4.9], Glidescope…”

mentioning

confidence: 99%

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Comparison of Glidescope Core, C-MAC Miller and conventional Miller laryngoscope for difficult airway management by anesthetists with limited and extensive experience in a simulated Pierre Robin sequence: A randomized crossover manikin study

et al. 2021

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Background Video laryngoscopy is an effective tool in the management of difficult pediatric airway. However, evidence to guide the choice of the most appropriate video laryngoscope (VL) for airway management in pediatric patients with Pierre Robin syndrome (PRS) is insufficient. Therefore, the aim of this study was to compare the efficacy of the Glidescope® Core™ with a hyperangulated blade, the C-MAC® with a nonangulated Miller blade (C-MAC® Miller) and a conventional Miller laryngoscope when used by anesthetists with limited and extensive experience in simulated Pierre Robin sequence. Methods Forty-three anesthetists with limited experience and forty-three anesthetists with extensive experience participated in our randomized crossover manikin trial. Each performed endotracheal intubation with the Glidescope® Core™ with a hyperangulated blade, the C-MAC® with a Miller blade and the conventional Miller laryngoscope. “Time to intubate” was the primary endpoint. Secondary endpoints were “time to vocal cords”, “time to ventilate”, overall success rate, number of intubation attempts and optimization maneuvers, Cormack-Lehane score, severity of dental trauma and subjective impressions. Results Both hyperangulated and nonangulated VLs provided superior intubation conditions. The Glidescope® Core™ enabled the best glottic view, caused the least dental trauma and significantly decreased the “time to vocal cords”. However, the failure rate of intubation was 14% with the Glidescope® Core™, 4.7% with the Miller laryngoscope and only 2.3% with the C-MAC® Miller when used by anesthetists with extensive previous experience. In addition, the “time to intubate”, the “time to ventilate” and the number of optimization maneuvers were significantly increased using the Glidescope® Core™. In the hands of anesthetists with limited previous experience, the failure rate was 11.6% with the Glidescope® Core™ and 7% with the Miller laryngoscope. Using the C-MAC® Miller, the overall success rate increased to 100%. No differences in the “time to intubate” or “time to ventilate” were observed. Conclusions The nonangulated C-MAC® Miller facilitated correct placement of the endotracheal tube and showed the highest overall success rate. Our results therefore suggest that the C-MAC® Miller could be beneficial and may contribute to increased safety in the airway management of infants with PRS when used by anesthetists with limited and extensive experience.

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Section: Introductionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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confidence: 99%

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Comparison of Glidescope Core, C-MAC Miller and conventional Miller laryngoscope for difficult airway management by anesthetists with limited and extensive experience in a simulated Pierre Robin sequence: A randomized crossover manikin study

et al. 2021

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“…All of these are great risks that anesthesiologists have to deal with [ 10 ]. The appropriate preoperative comprehensive score of PRS infants can help with difficult airway evaluation and optimized airway management strategy selection [ 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

Predictor of postoperative dyspnea for Pierre Robin Sequence infants

et al. 2020

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The aim of this retrospective study is to determine the predictive factors of postoperative dyspnea in infants with Pierre Robin sequence (PRS). Forty children with PRS, who underwent general anesthesia, were retrospectively analyzed. The patient’s physiological status and anesthesiology data were collected accordingly, demographic characteristics including age, gender, height and weight at surgery, weight gain, preoperative airway status, tracheal intubation route, American Society of Anesthesiologists grading and airway Cormack–Lehane classification. Weight gain, dyspnea before the operation, Cormack–Lehane grade distribution showed a significant difference between patients with and without postoperative dyspnea (p = 0.0175, p = 0.0026, and p = 0.0038, respectively). Incompetent weight gain was identified as a predictor (p = 0.0371) of PRS postoperative dyspnea through the binary logistic regression model. In conclusion, this study established an early alerting model by monitoring the weight gain, dyspnea before the operation, Cormack–Lehane grade as potential combinations to predict the risk of postoperative dyspnea for PRS.

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Kaban–Pruzansky Grade Predicts Airway Severity in Hemifacial Microsomia

Barrero

Pontell

Ryan

et al. 2023

Plastic &Amp; Reconstructive Surgery

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Background: Children born with hemifacial microsomia (HFM) can experience airway compromise. There is a paucity of data correlating degree of HFM severity with airway difficulty. This study aims to determine the relationship between the degree of micrognathia and airway insufficiency in the HFM population. Methods: Patient demographics, airway function, Kaban-Pruzansky (KP) grade, and Cormack-Lehane (CL) grade were collected and compared with appropriate statistics for HFM patients treated between 2000 and 2022.Results: Seventy patients underwent 365 operations with KP grading as follows: 34% KP grade I, 23% KP grade IIA, 11% KP grade IIB, and 33% KP grade III. Goldenhar syndrome was present in 40% of patients and 16% had bilateral disease. KP grade (P < 0.001) predicted mean number of airway-affecting procedures undergone and difficult airway status (P < 0.001), with 75% of difficult airways in KP grade III patients. There was no association of airway compromise with Goldenhar syndrome, laterality, or age (P > 0.05). Most CL grades were I (61%) or IIA (13%), with fewer grade IIB, grade III, and grade IV (4% to 7%). KP grade predicted CL grade (P < 0.001), with 71% of grade IV views and 64% of grade III views seen in KP grade III patients. Conclusions: KP grade correlated with airway severity in HFM. Patients do not appear to outgrow their CL grade, as previously hypothesized, suggesting that KP grade III patients remain at increased risk for airway insufficiency into the teen years. Given the potential significant morbidity associated with airway compromise, proper identification and preparation for a challenging airway is a critical part of caring for patients with HFM.

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A clinical prediction rule to identify difficult intubation in children with Robin sequence requiring mandibular distraction osteogenesis based on craniofacial CT measures

Cited by 5 publications

References 26 publications

Comparison of Glidescope Core, C-MAC Miller and conventional Miller laryngoscope for difficult airway management by anesthetists with limited and extensive experience in a simulated Pierre Robin sequence: A randomized crossover manikin study

Comparison of Glidescope Core, C-MAC Miller and conventional Miller laryngoscope for difficult airway management by anesthetists with limited and extensive experience in a simulated Pierre Robin sequence: A randomized crossover manikin study

Predictor of postoperative dyspnea for Pierre Robin Sequence infants

Kaban–Pruzansky Grade Predicts Airway Severity in Hemifacial Microsomia

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