Difficult intubation in paediatrics

Frei, Franz J.; Ummenhofer, Wolfgang

doi:10.1111/j.1460-9592.1996.tb00447.x

Cited by 81 publications

(57 citation statements)

References 141 publications

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“…Cormack and Lehane [46] proposed a classifi cation system based on the ability to visualize the glottic opening during laryngoscopy, although this type of assessment is probably more useful as a means to facilitate communication of the degree of diffi culty between providers and not as a screening tool for predicting a diffi cult airway at the bedside. The interincisor distance can also be assessed at this time-an interincisor distance less than two fi ngertips in breadth can be associated with a diffi cult airway [20,39]. Decreased range of motion at the atlanto-occipital joint leads to poor visualization of the glottis during laryngoscopy.…”

Section: Assessment and Preparationmentioning

confidence: 98%

“…Unfortunately, a recent retrospective analysis suggested that performing this kind of airway assessment was not feasible in 70% of critically ill adults [38]. An airway assessment may be even more diffi cult for children, as most of the reported techniques require cooperation on the part of the patient [20,39,40]. Moreover, most studies demonstrate that these bedside techniques have both poor interobserver agreement and positive predictive value [41,42].…”

Section: Assessment and Preparationmentioning

confidence: 99%

“…A Mallampati class of I or II predicts a relatively easy airway, whereas a Mallampati class >II predicts an increased diffi culty with adequate visualization of the airway during laryngoscopy. Critically ill patients with altered mental status or children may be unable to cooperate with this kind of assessment, although evaluation of the oropharyngeal airway with a tongue blade may be feasible and worthwhile [20,39,45]. Cormack and Lehane [46] proposed a classifi cation system based on the ability to visualize the glottic opening during laryngoscopy, although this type of assessment is probably more useful as a means to facilitate communication of the degree of diffi culty between providers and not as a screening tool for predicting a diffi cult airway at the bedside.…”

Section: Assessment and Preparationmentioning

confidence: 99%

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Assessment and Management of the Pediatric Airway

Wheeler

Spaeth

Mehta

et al. 2008

Resuscitation and Stabilization of the Critically Ill Child

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Anatomic features that differ between children and adults include (1) a proportionally larger head and occiput (relative to body size), causing neck fl exion and leading to potential airway obstruction when lying supine; (2) a relatively larger tongue, decreasing the size of the oral cavity; (3) decreased muscle tone, resulting in passive obstruction of the airway by the tongue; (4) a shorter, narrower, horizontally positioned, softer epiglottis; (5) cephalad and anterior position of the larynx; (6) shorter, smaller, narrower trachea; and (7) funnel-shaped versus cylindrical airway, such that the narrowest portion of the airway is located at the level of the cricoid cartilage (Figure 4.1).The fi rst and perhaps most obvious difference is that the pediatric airway is much smaller in diameter and shorter in length than the adult's. For example, the length of the trachea changes from approximately 4 cm in neonates to approximately 12 cm in adults, and the tracheal diameter varies from approximately 3 mm in the premature infant to approximately 25 mm in the adult [11,13]. According to Hagen-Poiseuille's law, the change in air fl ow resulting from a reduction in airway diameter is directly proportional to the airway radius elevated to the fourth power:

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Section: Assessment and Preparationmentioning

confidence: 98%

Section: Assessment and Preparationmentioning

confidence: 99%

Section: Assessment and Preparationmentioning

confidence: 99%

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Assessment and Management of the Pediatric Airway

Wheeler

Spaeth

Mehta

et al. 2008

Resuscitation and Stabilization of the Critically Ill Child

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“…Most anesthesiologists will be faced with few cases each year, particularly with the reduction in the need for endotracheal intubation brought about by the use of the LMA. Conducting randomized controlled trials is very difficult due to the small numbers of cases in each centre and therefore we rely on the advice of individual experts with unique experience 2,3 or on reviews of case studies 4 to provide us with practice guidelines. Surveying current practice and opinion of experienced clinicians can help to identify changes in practice, reinforce practice guidelines and assess the impact of new techniques and pharmacological approaches.…”

mentioning

confidence: 99%

“…2,3 Recent reviews have provided guidelines for developing an approach to the pediatric patient with a difficult airway. 4,5 Use of the flexible fibreoptic bronchoscopic (FOB) has become common practice amongst anesthesiologists and the availability of airway adjuncts such as laryngeal mask airway (LMA) and lighted stylet widespread. 6 Providing evidence for the best method of dealing with a difficult pediatric airway remains a challenge.…”

mentioning

confidence: 99%

Les anesthésiologistes pédiatriques canadiens préfèrent l’anesthésie par inhalation dans les cas de problèmes des voies aériennes: une enquête

Brooks

Ree

Rosen

et al. 2005

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : To survey Canadian pediatric anesthesiologists to assess practice patterns in managing pediatric patients with difficult airways.M Me et th ho od ds s: : Canadian pediatric anesthesiologists were invited to complete a web survey. Respondents selected their preferred anesthetic and airway management techniques in six clinical scenarios. The clinical scenarios involved airway management for cases where the difficulty was in visualizing the airway, sharing the airway and accessing a compromised airway.R Re es su ul lt ts s: : General inhalational anesthesia with spontaneous respiration was the preferred technique for managing difficult intubation especially in infants (90%) and younger children (97%), however, iv anesthesia was chosen for the management of the shared airway in the older child (51%) where there was little concern regarding difficulty of intubation. Most respondents would initially attempt direct laryngoscopy for the two scenarios of anticipated difficult airway (73% and 98%). The laryngeal mask airway is commonly used to guide fibreoptic endoscopy. The potential for complete airway obstruction would encourage respondents to employ a rigid bronchoscope as an alternate technique (17% and 44%).C Co on nc cl lu us si io on n: : Inhalational anesthesia remains the preferred technique for management of the difficult pediatric airway amongst Canadian pediatric anesthesiologists. Intravenous techniques are relatively more commonly chosen in cases where there is a shared airway but little concern regarding difficulty of intubation. In cases of anticipated difficult intubation, direct laryngoscopy remains the technique of choice and fibreoptic laryngoscopy makes a good alternate technique. The use of the laryngeal mask airway was preferred to facilitate fibreoptic intubation.O Ob bj je ec ct ti if f : : Mener une enquête auprès des anesthésiologistes canadiens en pédiatrie pour évaluer les modèles de pratique face aux problèmes de voies aériennes. M Mé ét th ho od de e : : L'enquête a été menée sur le Web. Les répondants ont sélectionné leurs techniques préférées d'anesthésie et de prise en charge des voies aériennes dans six scénarios cliniques dont des cas de visualisation difficile du larynx, de partage des voies aériennes et d'accès à des voies aériennes anormales.R Ré és su ul lt ta at ts s : : L'anesthésie générale par inhalation avec respiration spontanée à été préférée pour gérer l'intubation difficile chez les bébés (90 %) et les jeunes enfants (97 %), mais l'anesthésie iv a été choisie en cas de voies aériennes partagées chez les enfants plus âgés (51 %) quand on n'avait pas à se soucier vraiment de difficulté d'intubation. La majorité des répondants essayeraient d'abord la laryngoscopie directe pour les deux scénarios de problèmes anticipés d'intubation (73 % et 98 %). Le masque laryngé sert couramment de guide dans l'endoscopie fibroscopique. La possibilité d'obstruction complète des voies aériennes inciterait les répon-dants à employer un bronchoscope rigide comme techniq...

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