The effect of endotracheal tubes versus laryngeal mask airways on perioperative respiratory adverse events in infants: a randomised controlled trial

Drake‐Brockman, Thomas F. E.; Ramgolam, Anoop; Zhang, Guicheng; Hall, Graham L.; Ungern‐Sternberg, Britta S. von

doi:10.1016/s0140-6736(16)31719-6

Cited by 117 publications

(108 citation statements)

References 22 publications

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“…Thus, caution should be exercised should a supraglottic airway be implemented in individuals suffering from MPS/ML who present with progressive respiratory dysfunction or a narrowed upper airway. There is growing evidence that the laryngeal mask airway is associated with lower postoperative complication rates, as opposed to tracheal intubation in pediatric cohorts . Our data indicate that these findings should not be extrapolated without critical consideration to children with MPS/ML.…”

Section: Discussionmentioning

confidence: 66%

Airway management and perioperative adverse events in children with mucopolysaccharidoses and mucolipidoses: A retrospective cohort study

Dohrmann

Muschol

Sehner

et al. 2020

Pediatric Anesthesia

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Background Children suffering from mucopolysaccharidoses (subtypes I, II, III, IV, VI, and VII) or mucolipidoses often require anesthesia, but are at high risk for perioperative adverse events. However, the impact of the disease subtype and the standard of care for airway management are still unclear. Aims This study aimed to assess independent risk factors for perioperative adverse events in individuals with mucopolysaccharidoses/mucolipidoses and to analyze the interaction with the primary airway technique implemented. Methods This retrospective study included individuals with mucopolysaccharidoses/mucolipidoses who underwent anesthesia at two high‐volume centers from 2002 to 2016. The data were analyzed in a multivariate hierarchical model, accounting for repeated anesthesia procedures within the same patient and for multiple events within a single anesthesia. Results Of 141 identified inpatients, 67 (63 mucopolysaccharidoses and 4 mucolipidoses) underwent 269 anesthesia procedures (study cases) for 353 surgical or diagnostic interventions. At least one perioperative adverse event occurred in 25.6% of the cases. The risk for perioperative adverse events was higher in mucopolysaccharidoses type I (OR 8.0 [1.5‐42.7]; P = .014) or type II (OR 8.8 [1.3‐58.6]; P = .025) than in type III. Fiberoptic intubation through a supraglottic airway was associated with the lowest risk for perioperative adverse events and lowest conversion rate. Direct laryngoscopy was associated with a significantly higher risk for airway management problems than indirect techniques (estimated event rates 47.8% vs 10.1%, OR 24.05 [5.20‐111.24]; P < .001). The risk for respiratory adverse events was significantly higher for supraglottic airway (22.6%; OR 31.53 [2.79‐355.88]; P = .001) and direct laryngoscopy (14.8%; OR 14.70 [1.32‐163.44]; P = .029) than for fiberoptic intubation through a supraglottic airway (2.1%). Conclusions The disease subtype and primary airway technique were the most important independent risk factors for perioperative adverse events. Our findings indicate that in MPS/ML children with predicted difficult airway indirect techniques should be favored for the first tracheal intubation attempt.

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Section: Discussionmentioning

confidence: 66%

Airway management and perioperative adverse events in children with mucopolysaccharidoses and mucolipidoses: A retrospective cohort study

Dohrmann

Muschol

Sehner

et al. 2020

Pediatric Anesthesia

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“…Sir—Multiple recent studies have confirmed the efficacy and safety of different supraglottic devices designed for use in infants and young children . At this time, there are limited, if any, data on the dead space of these devices and therefore limited consideration for the impact of device selection on ventilation in very young infants and neonates.…”

Section: Summary Of Dead Space Volume In Each Device With Standard Dementioning

confidence: 99%

An in vitro analysis of the dead space in 5 supraglottic airway devices intended for use in small children and infants

Templeton

Goenaga‐Díaz

Templeton

et al. 2018

Pediatric Anesthesia

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“…For example, neonates and infants are at greater risk for airway complications while under sedation for MRI . While ETTs can be used to secure the airway, their use in infants and children may increase the risk of laryngospasm, bronchospasm, postoperative hoarse voice, and coughing when compared to SGAs . In a study of serial MRIs in children and adults under anesthesia, the use of an SGA was shown to significantly reduce motion artifact and improve image quality .…”

Section: Discussionmentioning

confidence: 99%

A retrospective study of the impact of supraglottic airway devices on the appearance of neck masses in children undergoing serial magnetic resonance imaging

Simpao

Obsekov

Gálvez

et al. 2018

Pediatric Anesthesia

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Summary Background General anesthesia and sedation are used routinely for magnetic resonance imaging (MRI) studies in children to optimize image quality. Airway devices such as supraglottic airways (SGAs) can alter the appearance of cervical soft tissue regions on an MRI and increase the risk of misdiagnosis. This phenomenon has not been well described in vivo. Aims We conducted this retrospective study to determine how often SGAs affected the appearance of neck masses in children who received multiple anesthetics for MRIs with and without an SGA. Methods We retrieved data on children 17 years old and younger who had multiple MRIs between January 2005 and January 2015. Inclusion criteria were patients with neck masses who had a SGA for at least one MRI and either a natural airway or endotracheal tube (ETT) for another MRI. We reviewed MRI images and imaging reports to determine if SGAs affected the appearance of neck masses. Results Twelve of the 921 patients who received anesthesia for neck MRIs during the study period met the inclusion criteria. SGAs affected the appearance of the neck mass in 11 of the 12 patients. Conclusions Supraglottic airways can significantly alter the appearance of neck masses in children undergoing MRIs and affect radiologists’ ability to assess those masses. Communication with the radiologist prior to the induction of anesthesia is crucial when using supraglottic devices in this patient population. It may be more prudent to use a different airway device and/or anesthetic technique when MRIs of these neck masses are undertaken.

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The effect of endotracheal tubes versus laryngeal mask airways on perioperative respiratory adverse events in infants: a randomised controlled trial

Cited by 117 publications

References 22 publications

Airway management and perioperative adverse events in children with mucopolysaccharidoses and mucolipidoses: A retrospective cohort study

Airway management and perioperative adverse events in children with mucopolysaccharidoses and mucolipidoses: A retrospective cohort study

An in vitro analysis of the dead space in 5 supraglottic airway devices intended for use in small children and infants

A retrospective study of the impact of supraglottic airway devices on the appearance of neck masses in children undergoing serial magnetic resonance imaging

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