Anesthetic experience of 100 pediatric tracheostomies

Abstract

This case series demonstrates that intubation is difficult in up to 26% of children presenting for tracheostomy. While intubation of the trachea remains the preferred option when anesthetizing children for tracheostomy, the LMA or facemask can provide a successful airway where intubation is not possible. The use of the LMA or facemask may therefore be life saving in the unintubatable child.

Proposal for the management of the unexpected difficult pediatric airway

“…The indications for the use of a tracheal tube must be critically evaluated, and if it is possible to maintain satisfactory oxygenation and ventilation with a facemask or SAD, urgent or life saving surgery can be undertaken (77).…”

A child with a difficult airway

“…Elective procedures for children with known difficult airways such as congenital or acquired problems (scars and burns) should, therefore, only be performed in these hospitals. Surgical tracheostomy may remain the only reliable and last option to secure the airway in these children [27]. The list of 'special tricks' available is long, not substantiated by a large evidence base, and beyond the scope of this article [14,26].…”

Algoritmo para el manejo de la vía aérea difícil en pediatría

“…En los casos severos donde existe una gran distorsión de la vía aérea se debe considerar realizar una traqueostomía profiláctica para garantizar la seguridad del paciente no solo durante el intraoperatorio, sino también durante el postoperatorio inmediato y el manejo durante toda la hospitalización 25 .…”