Les anesthésiologistes pédiatriques canadiens préfèrent l’anesthésie par inhalation dans les cas de problèmes des voies aériennes: une enquête

Abstract

P Pu ur rp po os se e: : To survey Canadian pediatric anesthesiologists to assess practice patterns in managing pediatric patients with difficult airways.M Me et th ho od ds s: : Canadian pediatric anesthesiologists were invited to complete a web survey. Respondents selected their preferred anesthetic and airway management techniques in six clinical scenarios. The clinical scenarios involved airway management for cases where the difficulty was in visualizing the airway, sharing the airway and accessing a compromised airway.R Re es su ul lt ts s: : General inhalational anesthesia with spontaneous respiration was the preferred technique for managing difficult intubation especially in infants (90%) and younger children (97%), however, iv anesthesia was chosen for the management of the shared airway in the older child (51%) where there was little concern regarding difficulty of intubation. Most respondents would initially attempt direct laryngoscopy for the two scenarios of anticipated difficult airway (73% and 98%). The laryngeal mask airway is commonly used to guide fibreoptic endoscopy. The potential for complete airway obstruction would encourage respondents to employ a rigid bronchoscope as an alternate technique (17% and 44%).C Co on nc cl lu us si io on n: : Inhalational anesthesia remains the preferred technique for management of the difficult pediatric airway amongst Canadian pediatric anesthesiologists. Intravenous techniques are relatively more commonly chosen in cases where there is a shared airway but little concern regarding difficulty of intubation. In cases of anticipated difficult intubation, direct laryngoscopy remains the technique of choice and fibreoptic laryngoscopy makes a good alternate technique. The use of the laryngeal mask airway was preferred to facilitate fibreoptic intubation.O Ob bj je ec ct ti if f : : Mener une enquête auprès des anesthésiologistes canadiens en pédiatrie pour évaluer les modèles de pratique face aux problèmes de voies aériennes. M Mé ét th ho od de e : : L'enquête a été menée sur le Web. Les répondants ont sélectionné leurs techniques préférées d'anesthésie et de prise en charge des voies aériennes dans six scénarios cliniques dont des cas de visualisation difficile du larynx, de partage des voies aériennes et d'accès à des voies aériennes anormales.R Ré és su ul lt ta at ts s : : L'anesthésie générale par inhalation avec respiration spontanée à été préférée pour gérer l'intubation difficile chez les bébés (90 %) et les jeunes enfants (97 %), mais l'anesthésie iv a été choisie en cas de voies aériennes partagées chez les enfants plus âgés (51 %) quand on n'avait pas à se soucier vraiment de difficulté d'intubation. La majorité des répondants essayeraient d'abord la laryngoscopie directe pour les deux scénarios de problèmes anticipés d'intubation (73 % et 98 %). Le masque laryngé sert couramment de guide dans l'endoscopie fibroscopique. La possibilité d'obstruction complète des voies aériennes inciterait les répon-dants à employer un bronchoscope rigide comme techniq...

Pediatric airway management

“…In one survey of pediatric anesthesiologist in Canada, the use of inhalational induction was the preferred method approaching a predicted difficult airway. [34]…”

A randomized comparison between the i-gel™ and the air-Q™ supraglottic airways when used by anesthesiology trainees as conduits for tracheal intubation in children

“…For these reasons, SGA-guided intubations are preferred by many pediatric anesthesiologists for the management of the difficult pediatric airway. 8 The air-Q TM SGA (Mercury Medical; Clearwater, FL, USA) is designed for tracheal intubation and has been shown to be an effective conduit for FOB-guided tracheal intubation in children. [9][10][11][12][13] The i-gel TM (Intersurgical; Wokingham, UK) is a newer SGA that has been shown to be effective for primary anesthetic maintenance, exhibiting higher airway leak pressures compared with other commonly utilized SGAs in children.…”

Assessment and management of the predicted difficult airway in babies and children

“…Many anaesthetists favour gas induction in this group. 8 A carefully titrated induction using propofol is also suitable when spontaneous ventilation is maintained.…”