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Difficult Airway Management of Neonates, Infants, and Children with Syndromes Involving the Airway

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Anesthetic Management for the Pediatric Airway

Abstract

Children with difficult airways are particularly vulnerable. Recognition of a potential difficult airway and preparation are the key to caring for them successfully. A simple checklist and teamwork can help optimize care. Introduce all team members, and review the induction and intubation plan with the entire team, including identifying the clinician making each intubation attempt. Identify an individual who is available to assist before beginning airway management. The following principles should guide the care of these patients:

  1. 1.

    Limit the number of tracheal intubation attempts.

  2. 2.

    Know your equipment. Be prepared.

  3. 3.

    Always attempt to oxygenate during intubation.

  4. 4.

    Ensure an adequate depth of anesthesia before instrumenting the airway.

  5. 5.

    Be wary of cognitive biases that may delay action.

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References

  1. Patel R, Lenczyk M, Hannallah RS, McGill WA. Age and the onset of desaturation in apnoeic children. Can J Anaesth. 1994;41(9):771–4.

    Article  CAS  PubMed  Google Scholar 

  2. Apfelbaum JL, Hagberg CA, Caplan RA, et al. Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology. 2013;118(2):251–70.

    Article  PubMed  Google Scholar 

  3. Habre W, Disma N, Virag K, et al. Incidence of severe critical events in paediatric anaesthesia (APRICOT): a prospective multicentre observational study in 261 hospitals in Europe. Lancet Respir Med. 2017;5(5):412–25.

    Article  PubMed  Google Scholar 

  4. Fiadjoe JE, Nishisaki A, Jagannathan N, et al. Airway management complications in children with difficult tracheal intubation from the pediatric difficult intubation (PeDI) registry: a prospective cohort analysis. Lancet Respir Med. 2016;4(1):37–48.

    Article  PubMed  Google Scholar 

  5. Valois-Gomez T, Oofuvong M, Auer G, Coffin D, Loetwiriyakul W, Correa JA. Incidence of difficult bag-mask ventilation in children: a prospective observational study. Paediatr Anaesth. 2013;23(10):920–6.

    Article  PubMed  Google Scholar 

  6. WHO Patient Safety & World Health Organization. WHO guidelines for safe surgery: 2009 :safe surgery saves lives. Geneva: World Health Organization; 2009.

    Google Scholar 

  7. Cook TM, Woodall N, Frerk C, Fourth National Audit P. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: anaesthesia. Br J Anaesth. 2011;106(5):617–31.

    Article  CAS  PubMed  Google Scholar 

  8. Long E, Cincotta D, Grindlay J, et al. Implementation of NAP4 emergency airway management recommendations in a quaternary-level pediatric hospital. Paediatr Anaesth. 2017;27(5):451–60.

    Article  PubMed  Google Scholar 

  9. Stiegler MP, Tung A. Cognitive processes in anesthesiology decision making. Anesthesiology. 2014;120(1):204–17.

    Article  PubMed  Google Scholar 

  10. Nargozian C. The airway in patients with craniofacial abnormalities. Paediatr Anaesth. 2004;14(1):53–9.

    Article  PubMed  Google Scholar 

  11. Heinrich S, Birkholz T, Ihmsen H, Irouschek A, Ackermann A, Schmidt J. Incidence and predictors of difficult laryngoscopy in 11,219 pediatric anesthesia procedures. Paediatr Anaesth. 2012;22(8):729–36.

    Article  PubMed  Google Scholar 

  12. Bai W, Golmirzaie K, Burke C, et al. Evaluation of emergency pediatric tracheal intubation by pediatric anesthesiologists on inpatient units and the emergency department. Paediatr Anaesth. 2016;26(4):384–91.

    Article  CAS  PubMed  Google Scholar 

  13. Schmutz J, Manser T. Do team processes really have an effect on clinical performance? A systematic literature review. Br J Anaesth. 2013;110(4):529–44.

    Article  CAS  PubMed  Google Scholar 

  14. Howarth D. Team working in airway crisis: role of operating department practitioner in management of failed intubations. Br J Anaesth. 2016;117(5):553–7.

    Article  CAS  PubMed  Google Scholar 

  15. Black AE, Flynn PE, Smith HL, et al. Development of a guideline for the management of the unanticipated difficult airway in pediatric practice. Paediatr Anaesth. 2015;25(4):346–62.

    Article  PubMed  Google Scholar 

  16. Holm-Knudsen RJ, Rasmussen LS, Charabi B, Bottger M, Kristensen MS. Emergency airway access in children–transtracheal cannulas and tracheotomy assessed in a porcine model. Paediatr Anaesth. 2012;22(12):1159–65.

    Article  PubMed  Google Scholar 

  17. Jagannathan N, Sohn L, Fiadjoe JE. Paediatric difficult airway management: what every anaesthetist should know! Br J Anaesth. 2016;117(Suppl 1):i3–5.

    Article  PubMed  Google Scholar 

  18. Escriba Alepuz FJ, Alonso Garcia J, Cuchillo Sastriques JV, Alcala E, Argente Navarro P. Emergency ventilation of infant subglottic stenosis through small-gauge lumen using the ventrain: a case report. A A Case Rep. 2018;10:136–8.

    Google Scholar 

  19. Sabato SC, Long E. An institutional approach to the management of the ‘Can’t Intubate, Can’t Oxygenate’ emergency in children. Paediatr Anaesth. 2016;26(8):784–93.

    Article  PubMed  Google Scholar 

  20. Booth AWG, Vidhani K. Human factors can’t intubate can’t oxygenate (CICO) bundle is more important than needle versus scalpel debate. Br J Anaesth. 2017;118(3):466–8.

    Article  CAS  PubMed  Google Scholar 

  21. Devys JM, Mourissoux G, Donnette FX, et al. Intubating conditions and adverse events during sevoflurane induction in infants. Br J Anaesth. 2011;106(2):225–9.

    Article  CAS  PubMed  Google Scholar 

  22. Erb TO, von Ungern-Sternberg BS, Moll J, Frei FJ. Impact of high concentrations of sevoflurane on laryngeal reflex responses. Paediatr Anaesth. 2017;27(3):282–9.

    Article  PubMed  Google Scholar 

  23. Lodenius A, Ebberyd A, Hardemark Cedborg A, et al. Sedation with dexmedetomidine or propofol impairs hypoxic control of breathing in healthy male volunteers: a nonblinded, randomized crossover study. Anesthesiology. 2016;125(4):700–15.

    Article  CAS  PubMed  Google Scholar 

  24. Shukry M, Kennedy K. Dexmedetomidine as a total intravenous anesthetic in infants. Paediatr Anaesth. 2007;17(6):581–3.

    Article  PubMed  Google Scholar 

  25. Seybold JL, Ramamurthi RJ, Hammer GB. The use of dexmedetomidine during laryngoscopy, bronchoscopy, and tracheal extubation following tracheal reconstruction. Paediatr Anaesth. 2007;17(12):1212–4.

    Article  PubMed  Google Scholar 

  26. Chen KZ, Ye M, Hu CB, Shen X. Dexmedetomidine vs remifentanil intravenous anaesthesia and spontaneous ventilation for airway foreign body removal in children. Br J Anaesth. 2014;112(5):892–7.

    Article  CAS  PubMed  Google Scholar 

  27. Potts AL, Anderson BJ, Holford NH, Vu TC, Warman GR. Dexmedetomidine hemodynamics in children after cardiac surgery. Paediatr Anaesth. 2010;20(5):425–33.

    Article  PubMed  Google Scholar 

  28. Mason KP, Zgleszewski S, Forman RE, Stark C, DiNardo JA. An exaggerated hypertensive response to glycopyrrolate therapy for bradycardia associated with high-dose dexmedetomidine. Anesth Analg. 2009;108(3):906–8.

    Article  PubMed  Google Scholar 

  29. Kovatsis PG, Fiadjoe JE. Those who cannot remember the past are condemned to repeat it. Paediatr Anaesth. 2016;26(4):333–4.

    Article  PubMed  Google Scholar 

  30. Humphreys S, Lee-Archer P, Reyne G, Long D, Williams T, Schibler A. Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) in children: a randomized controlled trial. Br J Anaesth. 2017;118(2):232–8.

    Article  CAS  PubMed  Google Scholar 

  31. Steiner JW, Sessler DI, Makarova N, et al. Use of deep laryngeal oxygen insufflation during laryngoscopy in children: a randomized clinical trial. Br J Anaesth. 2016;117(3):350–7.

    Article  CAS  PubMed  Google Scholar 

  32. Bordet F, Allaouchiche B, Lansiaux S, et al. Risk factors for airway complications during general anaesthesia in paediatric patients. Paediatr Anaesth. 2002;12(9):762–9.

    Article  PubMed  Google Scholar 

  33. Minogue SC, Ralph J, Lampa MJ. Laryngotracheal topicalization with lidocaine before intubation decreases the incidence of coughing on emergence from general anesthesia. Anesth Analg. 2004;99(4):1253–7. Table of contents.

    Article  CAS  PubMed  Google Scholar 

  34. Mihara T, Uchimoto K, Morita S, Goto T. The efficacy of lidocaine to prevent laryngospasm in children: a systematic review and meta-analysis. Anaesthesia. 2014;69(12):1388–96.

    Article  CAS  PubMed  Google Scholar 

  35. Hamilton ND, Hegarty M, Calder A, Erb TO, von Ungern-Sternberg BS. Does topical lidocaine before tracheal intubation attenuate airway responses in children? An observational audit. Paediatr Anaesth. 2012;22(4):345–50.

    Article  PubMed  Google Scholar 

  36. Dupanovic M, Isaacson SA, Borovcanin Z, et al. Clinical comparison of two stylet angles for orotracheal intubation with the GlideScope video laryngoscope. J Clin Anesth. 2010;22(5):352–9.

    Article  PubMed  Google Scholar 

  37. Park R, Peyton JM, Fiadjoe JE, et al. The efficacy of GlideScope(R) videolaryngoscopy compared with direct laryngoscopy in children who are difficult to intubate: an analysis from the paediatric difficult intubation registry. Br J Anaesth. 2017;119(5):984–92.

    Article  CAS  PubMed  Google Scholar 

  38. Singh R, Kumar N, Jain A. A randomised trial to compare Truview PCD(R), C-MAC(R) and Macintosh laryngoscopes in paediatric airway management. Asian J Anesthesiol. 2017;55(2):41–4.

    Article  PubMed  Google Scholar 

  39. Thakare DW, Malde AD. An observational study of feasibility of tracheal intubation using Airtraq in pediatric population. J Anaesthesiol Clin Pharmacol. 2017;33(3):365–70.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Raimann FJ, Cuca CE, Kern D, et al. Evaluation of the C-MAC miller video laryngoscope sizes 0 and 1 during tracheal intubation of infants less than 10 kg. Pediatr Emerg Care. 2017:1.

    Google Scholar 

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Correspondence to John E. Fiadjoe .

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Hsu, G., Fiadjoe, J.E. (2019). Difficult Airway Management of Neonates, Infants, and Children with Syndromes Involving the Airway. In: Preciado, D., Verghese, S. (eds) Anesthetic Management for the Pediatric Airway . Springer, Cham. https://doi.org/10.1007/978-3-030-04600-2_7

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  • DOI: https://doi.org/10.1007/978-3-030-04600-2_7

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-04599-9

  • Online ISBN: 978-3-030-04600-2

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