The effect of deep vs. awake extubation on respiratory complications in high-risk children undergoing adenotonsillectomy

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Perioperative respiratory complications following awake and deep extubation in children undergoing adenotonsillectomy

Baijal

Bidani

Minard

et al. 2014

“…They increase intracranial or intraocular pressure (eg, following open eye surgery) but also venous pressure in the head and neck and could favor bleeding (eg, following adenotonsillectomy and cleft palate repair). It should also be kept in mind that they are potential causes of laryngotracheal damage and bronchospasm and that they increase intrathoracic pressure with a risk of acute right to left shunting in case of intracardiac defect . Last but not least, coughing results in apnea at the end of a forced expiration and thus reduces the pulmonary O 2 reserve before extubation.…”

Section: Awake or Deep Extubation?mentioning

confidence: 99%

Tracheal extubation in children: Planning, technique, and complications

Veyckemans

2020

Although poorly described in textbooks and rarely a topic of lecture, tracheal extubation is a critical phase of anesthetic care. It should therefore be carefully planned taking into account simple physiology‐based principles to maintain the upper airway patent and avoid lung de‐recruitment, but also the pharmacology of all anesthetic agents used. Although the management of most of its complications can be learned in a clinical simulation environment, the basic techniques can so far only be taught at the bedside, in the operating room. In this paper, the process of extubation is described in successive steps: preparation, return to adequate spontaneous ventilation, awake versus deep extubation, timing according to the child's breathing cycle, extubation in the operating room or in the Postanesthesia Care unit, child's management immediately after extubation, diagnosis and treatment of the early complications, and finally, how to prepare for a difficult reintubation.

“…In skilled hands, the timing of extubation (awake vs. deep) in healthy children with normal airways does not appear to affect outcomes . However, the mantra in the low‐resource setting is to extubate children awake because of the variability in pediatric anesthesia training, support, and resources.…”

Section: Challenges In Postoperative Carementioning

confidence: 99%

Adaptations in pediatric anesthesia care and airway management in the resource‐poor setting

Manyumwa

Chimhundu-Sithole

Marange-Chikuni

et al. 2020

The need for safe and quality pediatric anesthesia care in low‐ and middle‐income countries (LMICs) is huge. An estimated 1.7 billion children do not have access to surgical care, and the majority are in LMICs. In addition, most LMICs do not have the requisite surgical workforce including anesthesia providers. Surgery is usually performed at three levels of facilities: district, provincial, and national referral hospitals. Unfortunately, the manpower, equipment, and other resources available to provide surgical care for children vary greatly at the different level facilities. The majority of district level hospitals are staffed solely by non‐physician anesthesia providers with variable training and little support to manage complicated pediatric patients. Airway and respiratory complications are known to account for a large portion of pediatric perioperative complications. Management of the difficult pediatric airway pathology is a challenge for anesthesia providers regardless of setting. However, in the low‐resource setting poor infrastructure, lack of transportation systems, and crippled referral systems lead to late presentation. There is often a lack of pediatric‐sized anesthesia equipment and resources, making management of the local pathology even more challenging. Efforts are being made to offer these providers additional training in pediatric anesthesia skills that incorporate low‐fidelity simulation. Out of necessity, anesthesia providers in this setting learn to be resourceful in order to manage complex pathologies with fewer, less ideal resources while still providing a safe anesthetic.