New airway device for ventilation and monitoring in pediatric patients undergoing MRI study

Abstract

A method of administering continuous positive airway pressure via a new airway device to prevent upper airway obstruction and preserve spontaneous respiration under total intravenous anesthesia has been adapted for children undergoing deep sedation for MRI studies. Presented herein is a retrospective study of 45 pediatric patients, ages 5 months to 7 years, who underwent an MRI study under general anesthesia using a modified nasal vestibule airway (NVA®), a pressure-sealing nasal cannula that can be used in conjunction with an anesthesia circuit to deliver nasal-CPAP during anesthesia. After inhalation induction of anesthesia with sevoflurane, an intravenous infusion of propofol was used to maintain anesthesia. A NVA®, downsized to fit the nasal vestibule of the child, was inserted, taped in place, and connected to a Mapleson F circuit. An extra long extension of corrugated tubing, a SNOR-SCOPE® circuit stethoscope, and the fluctuations of a reservoir bag allowed monitoring and assisted respirations from the foot of the MRI table. Other monitors included CO2 sampled at the mouth and the fluctuations of a PORTEX® disposable pressure gauge. The records of 45 pediatric patients were reviewed. No significant anesthesia complications were found. A new approach is offered to maintain airway patency, monitoring and spontaneous respirations in pediatric patients undergoing MRI study. This pressure-sealing nasal cannula can deliver CPAP under anesthesia while avoiding the requirement of an invasive airway and facilitating additional monitoring and control not possible with an ordinary nasal cannula. This NVA may be used in other locations in pediatric patients where endotracheal intubation is not necessary or impossible.

The Use of a Prototype MRI Safe Glidescope in a Pediatric Patient with CHARGE Syndrome: A Case Report

“…Most children require sedation, analgesia, anxiolysis to achieve the degree of cooperation or immobilization necessary to obtain satisfactory MRI images. Moreover, deep sedation is often required in pediatric patients, which may result in upper airway obstruction in spontaneously breathing patients [3]. Failed sedation in the pediatric population has been associated with greater age, higher ASA status (III and IV), and the use of benzodiazepines [4].…”

“…The potential for "help to arrive" in a timely manner is critical for neonates, infants and children. The margin of safety in the maintenance of a un-protected airway is significantly less in children and the MRI environment creates a unique set of potential risks and limitations [3]. This population has less functional residual capacity (FRC) and higher minute ventilation than adults.…”