Airway management complications in children with difficult tracheal intubation from the Pediatric Difficult Intubation (PeDI) registry: a prospective cohort analysis

Fiadjoe, John E.; Nishisaki, Akira; Jagannathan, Narasimhan; Hunyady, Ágnes; Greenberg, Robert S.; Reynolds, Paul I.; Matuszczak, Maria; Rehman, Mohamed A.; Polaner, David M.; Szmuk, Peter; Nadkarni, Vinay; McGowan, Francis X.; Litman, Ronald S.; Kovatsis, Pete G.

doi:10.1016/s2213-2600(15)00508-1

Cited by 355 publications

(400 citation statements)

References 25 publications

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“…Ventilation and oxygenation using a face mask and laryngeal mask are more important than tracheal intubation. These approaches save lives and can be performed successfully even in a child with a difficult or compromised airway . Repeated attempts of performing direct laryngoscopy in these children often lead to hypoxemia, edema, and airway trauma, which can deteriorate the situation and undermine successful ventilation.…”

Section: Choosing Wisely In Pediatric Anesthesia: 10 Dos and Don′tsmentioning

confidence: 99%

Choosing Wisely in pediatric anesthesia: An interpretation from the German Scientific Working Group of Paediatric Anaesthesia (WAKKA)

Becke

Eich

Höhne

et al. 2018

Pediatric Anesthesia

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Inspired by the Choosing Wisely initiative, a group of pediatric anesthesiologists representing the German Working Group on Paediatric Anaesthesia (WAKKA) coined and agreed upon 10 concise positive ("dos") or negative ("don'ts") evidence-based recommendations. (i) In infants and children with robust indications for surgical, interventional, or diagnostic procedures, anesthesia or sedation should not be avoided or delayed due to the potential neurotoxicity associated with the exposure to anesthetics. (ii) In children without relevant preexisting illnesses (ie, ASA status I/II) who are scheduled for elective minor or medium-risk surgical procedures, no routine blood tests should be performed. (iii) Parental presence during the induction of anesthesia should be an option for children whenever possible. (iv) Perioperative fasting should be safe and child-friendly with shorter real fasting times and more liberal postoperative drinking and enteral feeding. (v) Perioperative fluid therapy should be safe and effective with physiologically composed balanced electrolyte solutions to maintain a normal extracellular fluid volume; addition of 1%-2.5% glucose to avoid lipolysis, hypoglycemia, and hyperglycemia, and colloids as needed to maintain a normal blood volume. (vi) To achieve safe and successful airway management, the locally accepted airway algorithm and continued teaching and training of basic and alternative techniques of ventilation and endotracheal intubation are required. (vii) Ultrasound and imaging systems (eg, transillumination) should be available for achieving central venous access and challenging peripheral venous and arterial access. (viii) Perioperative disturbances of the patient's homeostasis, such as hypotension, hypocapnia, hypothermia, hypoglycemia, hyponatremia, and severe anemia, should not be ignored and should be prevented or treated immediately. (ix) Pediatric patients with an elevated perioperative risk, eg, preterm and term neonates, infants, and critically ill children, should be treated at institutions where all caregivers have sufficient expertise and continuous clinical exposure to such patients. (x) A strategy for preventing postoperative vomiting, emergence delirium, and acute pain should be a part of every anesthetic procedure.

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Section: Choosing Wisely In Pediatric Anesthesia: 10 Dos and Don′tsmentioning

confidence: 99%

Choosing Wisely in pediatric anesthesia: An interpretation from the German Scientific Working Group of Paediatric Anaesthesia (WAKKA)

Becke

Eich

Höhne

et al. 2018

Pediatric Anesthesia

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“…Direct laryngoscopy requires alignment of the oropharyngeal-laryngeal axes, and these differences restrict optimal visualization of the glottis. The management of a difficult airway in infants with a weight of less than 10 kg has always been a challenge [4]. Fortunately, an unanticipated difficult airway is extremely rare in infants; however, the overall incidence of difficult laryngoscopy (Cormack & Lehane Class ≥ III) is significantly higher in patients < 12 months of age (4.7% vs. 0.7%) than in older children [1, 4].…”

Section: Introductionmentioning

confidence: 99%

A comparison of two hyperangulated video laryngoscope blades to direct laryngoscopy in a simulated infant airway: a bicentric, comparative, randomized manikin study

et al. 2018

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BackgroundIn infants, securing the airway is time-critical because of anatomical and physiological differences related to airway management in children less than 1 year old. The aim of this study was to compare the time to ventilation using two different hyperangulated video laryngoscope blades with the time to ventilation via conventional direct laryngoscopy in a normal airway [NA] and in a simulated difficult airway [DA].MethodsThis study was a comparative, bicentric, open-label, randomized controlled evaluation. An infant high-fidelity simulator (SimBaby™; Laerdal® Medical, Stavanger, Norway) was used, and two scenarios were proposed, as follows: NA and DA evoked with tongue edema and cervical collar. After theoretical and practical briefing, each participant compared in the two airway scenarios the novel King Vision™ Pediatric aBlade (KV) (Ambu® A/S, Bad Nauheim, Germany) video laryngoscope and the C-MAC™ D-blade Ped (DB) (Karl Storz® SE & Co. KG, Tuttlingen, Germany) video laryngoscope to conventional laryngoscopy using the Miller Blade (MiB) and the Macintosh Blade (MaB) in a random sequence.ResultsEighty physicians (65 AN and 15 PCCM staff) were included. In the NA scenario, the median [IQR] time to successful time to ventilation (TTV) was significantly shorter for the KV at 13 s [12–15 s] than for the MaB at 14.5 s [13–16 s], DB at 14.5 s [13–16] and MiB at 16 s [14–19] (p < 0.001). In DA, the KV also shortened TTV to 14 s [13–16], whereas TTV was 23 s with the MaB [20–26], 19 s with the DB [16–21], and 27 s with the MiB [22–31] (p < 0.001). There were no differences in first-pass intubation success rates (FPAs) between hyperangulated blades and direct laryngoscopes in NA. In DA, the hyperangulated blades enabled 92 (DB) to 100% (KV) FPAs compared with 65 (MiB) to 76% (MaB) for conventional laryngoscopy (p < 0.001).ConclusionVideo laryngoscopes with hyperangulated blades were associated with shorter TTV in normal and difficult infant airway situations. The higher FPAs of hyperangulated blades in DA may avoid desaturations and decrease adverse events in pediatric airway management.Electronic supplementary materialThe online version of this article (10.1186/s12871-018-0580-y) contains supplementary material, which is available to authorized users.

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“…Critical airway incidents in children are a frequent problem in pediatric anesthesia and remain a significant cause of morbidity and mortality . Young children are at particular risk in the perioperative period .…”

Section: Introductionmentioning

confidence: 99%

A framework for the management of the pediatric airway

Engelhardt

Fiadjoe

Weiß

et al. 2019

Pediatric Anesthesia

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Summary Critical airway incidents in children are a frequent problem in pediatric anesthesia and remain a significant cause of morbidity and mortality. Young children are at particular risk in the perioperative period. Delayed management of airway obstruction can quickly lead to serious complications due to the short apnea tolerance in children. A simple, time critical, and pediatric‐specific airway management approach combined with dedicated teaching, training, and frequent practice will help to reduce airway‐related pediatric morbidity and mortality. There is currently no pediatric‐specific universal framework available to guide practice. Current algorithms are modifications of adult approaches which are often inappropriate because of differences in age‐related anatomy, physiology, and neurodevelopment. A universal and pragmatic approach is required to achieve acceptance across diverse pediatric clinicians, societies, and groups. Such a framework will also help to establish minimum standards for pediatric airway equipment, personnel, and medications whenever pediatric airway management is required.

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Airway management complications in children with difficult tracheal intubation from the Pediatric Difficult Intubation (PeDI) registry: a prospective cohort analysis

Cited by 355 publications

References 25 publications

Choosing Wisely in pediatric anesthesia: An interpretation from the German Scientific Working Group of Paediatric Anaesthesia (WAKKA)

Choosing Wisely in pediatric anesthesia: An interpretation from the German Scientific Working Group of Paediatric Anaesthesia (WAKKA)

A comparison of two hyperangulated video laryngoscope blades to direct laryngoscopy in a simulated infant airway: a bicentric, comparative, randomized manikin study

A framework for the management of the pediatric airway

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