Anaesthesia for complex airway surgery in children

Oshan, Vimmi; Walker, Robert

doi:10.1093/bjaceaccp/mks058

Cited by 14 publications

(15 citation statements)

References 7 publications

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“…A compromised airway is a preexisting risk factor of airway loss during the induction of anesthesia (6). The safest way to prevent a partially obstructed airway from developing into complete obstruction is to keep the patient breathing spontaneously for as long as possible (4).…”

Section: Discussionmentioning

confidence: 99%

“…The primary management strategy is surgical removal of the tumor under a laryngoscope at frequent intervals to relieve symptoms of airway obstruction (3). A spontaneous ventilation technique is preferred in children with upper airway obstruction, since this technique maintains a degree of muscle tone and helps to maintain gas exchange (4). Sevoflurane is widely used for anesthesia induction in pediatric population (5).…”

Section: Introductionmentioning

confidence: 99%

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Airway loss during inhalation induction of anesthesia with sevoflurane in a pediatric patient with laryngeal papillomatosis: A case report

Shen

2015

Experimental and Therapeutic Medicine

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Abstract. The aim of the present study was to report a failed inhalation induction of anesthesia with sevofluran in a pediatric patient with grade III laryngeal obstruction caused by laryngeal papillomatosis. Inhalation induction is recommended for the induction of anesthesia in pediatric patients. In the present case, due to the respiratory depression properties of the anesthetics, the partial airway obstruction developed into complete airway obstruction, followed by cardiac arrest. The patient survived after the surgeon managed to reconvert the complete airway obstruction into partial airway obstruction through the removal of part of the laryngeal papillomas. In conclusion, the reaction of the patient in the present case to sevoflurane inhalation induction suggests that this technique is not recommended for patients with pre-existing severe airway obstruction. In such cases, special consideration and preparation is required.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Airway loss during inhalation induction of anesthesia with sevoflurane in a pediatric patient with laryngeal papillomatosis: A case report

Shen

2015

Experimental and Therapeutic Medicine

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“…The surgical options are based on the type of laryngomalacia and include division of the aryepiglottic folds, resection of excess arytenoid tissue, and suspension of the prolapsing epiglottis …”

Section: Common Pediatric Airway Pathologymentioning

confidence: 99%

“…Treatment includes conservative management for asymptomatic type 1 clefts, endoscopic repair for symptomatic type 1, 2, and some 3 clefts, to open repair requiring cardiopulmonary bypass for a type 4 cleft …”

Section: Common Pediatric Airway Pathologymentioning

confidence: 99%

Anesthesia for shared airway surgery in children

Bradley

Lee

Peyton

2020

Pediatric Anesthesia

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Shared airway surgery in children is a complex, high‐risk undertaking that requires continuous communication and cooperation between the anesthetic and surgical teams. Airway abnormalities commonly seen in children, the surgical options, and the anesthetic techniques that can be used to care for this vulnerable population are discussed. Many of these procedures were traditionally carried out using jet ventilation, or intermittent tracheal intubation, but increasingly spontaneously breathing “tubeless” techniques are being used. This review has been written from both the surgical and anesthetic perspective, highlighting the concerns that both specialties have in relation to the maintenance of surgical access and operating conditions, and the need for the provision of anesthesia, oxygenation, and ventilation where the airway is the primary site of operation.

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“…Spontaneous ventilation is indicated for an inhaled foreign body to maximize V/Q matching, and prevent ipsilateral hyperinflation and barotrauma and, for a planned difficult airway, to preserve upper airway tone, maintain adequate gaseous exchange, prevent hypoxia, and minimize the chance of losing a clear airway . TIVA can be easily titrated to maintain SV, but consideration must be given to: the age of child, slow speed of induction to maintain normal P a CO 2 , the specific agent effects on respiratory rate, and the appropriate predicted targets in processed electroencephalographic (pEEG) monitoring or respiratory rate …”

Section: What Are the 3 Main Advantages Of Your Technique In Airways?mentioning

confidence: 99%

Volatiles or TIVA: Which is the standard of care for pediatric airway procedures? A pro‐con discussion

Lauder

Thomas

Ungern‐Sternberg

et al. 2020

Pediatric Anesthesia

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Anesthesia for pediatric airway procedures constitutes a true art form that requires training and experience. Communication between anesthetist and surgeon to establish procedure goals is essential in determining the most appropriate anesthetic management. But does the mode of anesthesia have an impact? Traditionally, inhalational anesthesia was the most common anesthesia technique used during airway surgery. Introduction of agents used for total intravenous anesthesia (TIVA) such as propofol, short‐acting opioids, midazolam, and dexmedetomidine has driven change in practice. Ongoing debates abound as to the advantages and disadvantages of volatile‐based anesthesia versus TIVA. This pro‐con discussion examines both volatiles and TIVA, from the perspective of effectiveness, safety, cost, and environmental impact, in an endeavor to justify which technique is the best specifically for pediatric airway procedures.

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Anaesthesia for complex airway surgery in children

Cited by 14 publications

References 7 publications

Airway loss during inhalation induction of anesthesia with sevoflurane in a pediatric patient with laryngeal papillomatosis: A case report

Airway loss during inhalation induction of anesthesia with sevoflurane in a pediatric patient with laryngeal papillomatosis: A case report

Anesthesia for shared airway surgery in children

Volatiles or TIVA: Which is the standard of care for pediatric airway procedures? A pro‐con discussion

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