Our formula for cuffed tube selection is appropriate for young children. Advantages of cuffed endotracheal tubes include avoidance of repeated laryngoscopy, use of low fresh gas flow, and reduction of the concentration of anesthetics detectable in the operating room. We conclude that cuffed endotracheal tubes may be used routinely during controlled ventilation in full-term newborns and children during anesthesia.

No abstract

The severe acute respiratory syndrome coronavirus 2 (coronavirus disease 2019 [COVID-19]) pandemic has challenged medical systems and clinicians globally to unforeseen levels. Rapid spread of COVID-19 has forced clinicians to care for patients with a highly contagious disease without evidence-based guidelines. Using a virtual modified nominal group technique, the Pediatric Difficult Intubation Collaborative (PeDI-C), which currently includes 35 hospitals from 6 countries, generated consensus guidelines on airway management in pediatric anesthesia based on expert opinion and early data about the disease. PeDI-C identified overarching goals during care, including minimizing aerosolized respiratory secretions, minimizing the number of clinicians in contact with a patient, and recognizing that undiagnosed asymptomatic patients may shed the virus and infect health care workers. Recommendations include administering anxiolytic medications, intravenous anesthetic inductions, tracheal intubation using video laryngoscopes and cuffed tracheal tubes, use of in-line suction catheters, and modifying workflow to recover patients from anesthesia in the operating room. Importantly, PeDI-C recommends that anesthesiologists consider using appropriate personal protective equipment when performing aerosol-generating medical procedures in asymptomatic children, in addition to known or suspected children with COVID-19. Airway procedures should be done in negative pressure rooms when available. Adequate time should be allowed for operating room cleaning and air filtration between surgical cases. Research using rigorous study designs is urgently needed to inform safe practices during the COVID-19 pandemic. Until further information is available, PeDI-C advises that clinicians consider these guidelines to enhance the safety of health care workers during airway management when performing aerosol-generating medical procedures. These guidelines have been endorsed by the Society for Pediatric Anesthesia and the Canadian Pediatric Anesthesia Society.

Several independent indicators imply a high probability of a great (M N 8) earthquake rupture of the subduction megathrust under the Mentawai Islands of West Sumatra. The human consequences of such an event depend crucially on its tsunamigenic potential, which in turn depends on unpredictable details of slip distribution on the megathrust and how resulting seafloor movements and the propagating tsunami waves interact with bathymetry. Here we address the forward problem by modelling about 1000 possible complex earthquake ruptures and calculating the seafloor displacements and tsunami wave height distributions that would result from the most likely 100 or so, as judged by reference to paleogeodetic data. Additionally we carry out a systematic study of the importance of the location of maximum slip with respect to the morphology of the fore-arc complex. Our results indicate a generally smaller regional tsunami hazard than was realised in Aceh during the December 2004 event, though more than 20% of simulations result in tsunami wave heights of more than 5 m for the southern Sumatran cities of Padang and Bengkulu. The extreme events in these simulations produce results which are consistent with recent deterministic studies. The study confirms the sensitivity of predicted wave heights to the distribution of slip even for events with similar moment and reproduces Plafker's rule of thumb. Additionally we show that the maximum wave height observed at a single location scales with the magnitude though data for all magnitudes exhibit extreme variability. Finally, we show that for any coastal location in the near field of the earthquake, despite the complexity of the earthquake rupture simulations and the large range of magnitudes modelled, the timing of inundation is constant to first order and the maximum height of the modelled waves is directly proportional to the vertical coseismic displacement experienced at that point. These results may assist in developing tsunami preparedness strategies around the Indian Ocean and in particular along the coasts of western Sumatra.