Anaesthesia and the Ventilatory System in Infants and Young Children

Experimental model of laryngotracheal stenosis in infants: effects of different high‐frequency jet ventilation patterns on pulmonary parameters

“…Supraglottic HFJV ensures oxygenation and ventilation and offers the surgeon an unimpaired operating field. According to our experimental results, supraglottic HFJV seems to be able to ensure adequate ventilation and provide acceptable PEEP levels (10,11). The efficacy and safety for ventilation and oxygenation during this specific kind of surgery is not clearly established and guidelines for the use of such techniques would be welcome (15).…”

“…The characteristics of the respiratory system of infants in contrast to adults are the unstable functional residual capacity (FRC), a lower compliance (C) and a higher resistance (R). Therefore, a PEEP in artificial ventilation of newborns and infants (10,11) is preferable and its occurrence in an acceptable level during supraglottic HFJV might be advantageous. Varied techniques of airway management and anesthesia during endolaryngotracheal surgery in children are in clinical practice.…”

A timed reexpansion inspiratory manoeuvre (TRIM) for treating oxyhaemoglobin desaturation in children following a period of apnoea—studies in an animal model

“…Following induction of general anaesthesia pul‐ monary gas exchange is known to be impaired which may result in hypoxaemia ( 1–4). Children are more susceptible to oxyhaemoglobin desaturation because their functional residual capacity is smaller and oxygen consumption, in relation to body weight, is greater ( 5–7).…”

“…Critical incidents during paediatric anaesthesia are most frequently respiratory in origin ( 16–18). Children have a decreased respiratory reserve and a greater tendency to atelectasis ( 4). It has been demonstrated that, following a period of apnoea, desaturation occurs more rapidly in younger children and those with signs of respiratory tract infection ( 8, 9).…”

Methylxanthines for the treatment of apnea associated with bronchiolitis and anesthesia

“…This adoption of conservative parameters that define apnea related to anesthesia is possibly because the postoperative period is a time of altered cardiovascular and respiratory physiology. Inhalational anesthetic agents and opioids, for example, affect respiratory drive and lung mechanics adversely (14). If anesthetists adopted the accepted definitions of apnea, desaturation and bradycardia then the incidence of these events may be reduced, but intervention at an early stage of decompensation or before decompensation occurs is a safer pragmatic approach during the postoperative period.…”