Sedation and anesthesia for fiberoptic intubation in management of pediatric difficult airways

Walk a Tightrope or Burn a Bridge?: Sedation versus General Anesthesia for Intubation of a Pediatric Difficult Airway

“…1 In contrast, there are some who decry general anesthesia may "burn the bridge" of spontaneous ventilation and instead choose to walk the tightrope of sedation that is deep enough to diminish airway responses yet light enough to maintain spontaneous ventilation and reverse course if airway management is too treacherous. 5 In this issue of Anesthesiology, Sequera-Ramos et al 6 drew on data from the Pediatric Difficult Intubation registry with the aim of comparing outcomes associated with sedation versus general anesthesia for tracheal intubation in children with difficult airways. Sequera-Ramos et al 6 used propensity score matching to address selection bias and other confounders inherent in the analysis of retrospective observational, real-world clinical data.…”

“…1 In contrast, there are some who decry general anesthesia may “burn the bridge” of spontaneous ventilation and instead choose to walk the tightrope of sedation that is deep enough to diminish airway responses yet light enough to maintain spontaneous ventilation and reverse course if airway management is too treacherous. 5…”

Airway anesthesia for awake fiberoptic intubation in management of pediatric difficult airways

“…Also airway procedure must be gently done and should be stopped if children show significant discomfort. In preparing the patient for AFI, in addition to airway anesthesia, providing adequate sedation is important because a calm and comfortable child is much more likely to cooperate with the anesthetist during airway manipulation. In our institution, a sedation‐analgesia regimen with a combination of midazolam and opioid drugs is favored (4). Because secretions in the airway may impede effective airway anesthesia, preoperative administration of antisialagogues is necessary. Spraying of a local anesthetic solution onto the airway by an atomizer or a metered‐dose inhaler is a relatively simple method.…”

“…In preparing the patient for AFI, in addition to airway anesthesia, providing adequate sedation is important because a calm and comfortable child is much more likely to cooperate with the anesthetist during airway manipulation. In our institution, a sedation‐analgesia regimen with a combination of midazolam and opioid drugs is favored (4). Because secretions in the airway may impede effective airway anesthesia, preoperative administration of antisialagogues is necessary.…”