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The Pediatric Difficult Airway

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Abstract

It is a common adage in pediatric anesthesia practice that: “children are not small adults”, and in airway management this is especially true. The anatomical and physiological characteristics of children, together with developmental changes, make a careful and thorough approach necessary to guarantee success.

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References

  1. Eckenhoff JE (1951) Some anatomic considerations of the infant larynx influencing endotracheal anesthesia. Anesthesiology 12:401–410

    Article  CAS  PubMed  Google Scholar 

  2. Litman RS, Weissend EE, Shibata D et al (2003) Developmental changes of laryngeal dimensions in unparalyzed, sedated children. Anesthesiology 98:41–45

    Article  PubMed  Google Scholar 

  3. Litman RS, Wake N, Chan LM et al (2005) Effect of lateral positioning on upper airway size and morphology in sedated children. Anesthesiology 103:484–488

    Article  PubMed  Google Scholar 

  4. Litman RS, Weissend EE, Shrier DA et al (2002) Morphologic changes in the upper airway of children during awakening from propofol administration. Anesthesiology 96:607–611

    Article  CAS  PubMed  Google Scholar 

  5. Dalal PG, Feng A, Molter D et al (2007) Morphologic changes in the pediatric epiglottis: an age-based comparison in normal children using video-bronchoscopy (abstract P45). Society for Pediatric Anesthesia. Pediatric Anesthesiology (2007 Winter Meeting), Phoenix

    Google Scholar 

  6. Reber A (2004) The pediatric upper airway: anaesthetic aspects and conclusions. Curr Opin Anaesthesiol 17:217–221

    Article  PubMed  Google Scholar 

  7. Farmery AD, Roe PG (1996) A model to describe the rate of oxyhaemoglobin desaturation during apnoea. Br J Anaesth 76:284–291

    CAS  PubMed  Google Scholar 

  8. Wheeler M (1998) Management strategies for the difficult pediatric airway. Anesthesiol Clin North America 16:743–761

    Article  Google Scholar 

  9. American Society of Anesthesiologists Task Force on Management of the Difficult Airway (2003) 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 98:1269–1277

    Article  Google Scholar 

  10. Frei FJ, Ummenhofer W (1996) Difficult intubation in paediatrics. Paediatr Anaesth 6:251–263

    Article  CAS  PubMed  Google Scholar 

  11. Shiga T, Wajima Z, Inoue T et al (2005) Predicting difficult intubation in apparently normal patients: a meta-analysis of bedside screening test performance. Anesthesiology 103:429–437

    Article  PubMed  Google Scholar 

  12. Tong DC, Litman RS (2007) The Children’s Hospital of Philadelphia Difficult Intubation Registry (abstract P43). Society for Pediatric Anesthesia. Pediatric Anesthesiology (2007 Winter Meeting), Phoenix

    Google Scholar 

  13. Akpek EA, Mutlu H, Kayhan Z (2004) Difficult intubation in pediatric cardiac anesthesia. J Cardiothorac Vasc Anesth 18:610–612

    Article  PubMed  Google Scholar 

  14. Bevilacqua S, Nicolini A, Del Sarto P (1996) Difficult intubation in paediatric cardiac surgery. Significance of age. Association with Down’s syndrome. Minerva Anestesiol 62:259–264

    CAS  PubMed  Google Scholar 

  15. Hall SC (2001) The difficult pediatric airway — recognition evaluation, and management. Can J Anesth 48:R1–R5

    Article  Google Scholar 

  16. Baum VC, O’Flaherty JE (2006) Anesthesia for genetic, metabolic & dysmorphic syndromes of childhood, 2nd edn. Lippincott Williams and Wilkins, Philadelphia

    Google Scholar 

  17. Tait AR, Malviya S (2005) Anesthesia for the child with an upper respiratory tract infection: still a dilemma? Anesth Analg 100:59–65

    Article  PubMed  Google Scholar 

  18. Gross JB, Bachenberg KL, Benumof JL et al (2006) Practice guidelines for the perioperative management of patients with obstructive sleep apnea: a report by the American Society of Anesthesiologists Task Force on Perioperative Management of patients with obstructive sleep apnea. Anesthesiology 104:1081–1093

    Article  PubMed  Google Scholar 

  19. Gregory GA, Riazi J (1998) Classification and assessment of the difficult pediatric airway. Anesthesiol Clin North America 16:729–741

    Article  Google Scholar 

  20. Constant I (2003) Choosing an endotracheal intubation set in paediatric anaesthesia (in French). Ann Fr Anesth Reanim 22:890–895

    CAS  PubMed  Google Scholar 

  21. Ecoffey C (2003) Laryngeal mask airway in paediatrics: when? How? (in French). Ann Fr Anesth Reanim 22:648–652

    Article  CAS  PubMed  Google Scholar 

  22. Selim M, Mowafi H, Al-Ghamdi A et al (1999) Intubation via LMA in pediatric patients with difficult airways. Can J Anaesth 46:891–893

    Article  CAS  PubMed  Google Scholar 

  23. Goldmann K (2006) Recent developments in airway management of the paediatric patient. Curr Opin Anaesthesiol 19:278–284

    Article  PubMed  Google Scholar 

  24. Goldmann K, Roettger C, Wulf H (2006) The size 1(1/2) ProSeal laryngeal mask airway in infants: a randomized, crossover investigation with the Classic laryngeal mask airway. Anesth Analg 102:405–410

    Article  PubMed  Google Scholar 

  25. Bordet F, Allaouchiche B, Lansiaux S et al (2002) Risk factors for airway complications during general anaesthesia in paediatric patients. Paediatr Anaesth 12:762–769

    Article  PubMed  Google Scholar 

  26. Polaner DM (2006) Supraglottic devices in pediatrics. Proceedings of the Fifth International Symposium on the Pediatric Airway, Pittsburgh, PA, 8-11 June 2006

    Google Scholar 

  27. American Academy of Pediatrics/American College of Emergency Physicians (2007) APLS course manual (4th edn). American Academy of Pediatrics, Elk Grove Village, IL

    Google Scholar 

  28. Dullenkopf A, Gerber AC, Weiss M (2005) Fit and seal characteristics of a new paediatric tracheal tube with high volume-low pressure polyurethane cuff. Acta Anaesthesiol Scand 49:232–237

    Article  CAS  PubMed  Google Scholar 

  29. Weiss M, Dullenkopf A, Bottcher S et al (2006) Clinical evaluation of cuff and tube tip position in a newly designed paediatric preformed oral cuffed tracheal tube. Br J Anaesth 97:695–700

    Article  CAS  PubMed  Google Scholar 

  30. Marraro GA (2001) Airway management. In: Bissonnette B, Dalens BJ (eds) Pediatric anesthesia: principles and practice. McGraw-Hill, New York, p 778

    Google Scholar 

  31. von Ungern-Sternberg BS, Erb TO, Reber A et al (2005) Opening the upper airway — airway maneuvers in pediatric anesthesia. Paediatr Anaesth 15:181–189

    Article  Google Scholar 

  32. Wheeler M (2000) The difficult pediatric airway. In: Hagberg CA (ed) Handbook of difficult airway management, 1st edn. Churchill Livingstone, London, pp 257–300

    Google Scholar 

  33. von Ungern-Sternberg BS, Erb TO, Frei FJ (2005) Jaw thrust can deteriorate upper airway patency. Acta Anaesthesiol Scand 49:583–585

    Article  Google Scholar 

  34. Larson CP Jr (1998) Laryngospasm — the best treatment. Anesthesiology 89:1293–1294

    Article  PubMed  Google Scholar 

  35. Nussbaum E, Zagnoev M (2001) Pediatric fiberoptic bronchoscopy with a laryngeal mask airway. Chest 120:614–616

    Article  CAS  PubMed  Google Scholar 

  36. Kandasamy R, Sivalingam P (2000) Use of sevoflurane in difficult airways. Acta Anaesthesiol Scand 44:627–629

    Article  CAS  PubMed  Google Scholar 

  37. Ansermino JM, Brooks P, Rosen D et al (2005) Spontaneous ventilation with remifentanil in children. Paediatr Anaesth 15:115–121

    Article  PubMed  Google Scholar 

  38. Abdelmalak B, Makary L, Hoban J et al (2007) Dexmedetomidine as sole sedative for awake intubation in management of the critical airway. J Clin Anesth 19:370–373

    Article  CAS  PubMed  Google Scholar 

  39. Bergese SD, Khabiri B, Roberts WD et al (2007) Dexmedetomidine for conscious sedation in difficult awake fiberoptic intubation cases. J Clin Anesth 19:141–144

    Article  CAS  PubMed  Google Scholar 

  40. Scher CS, Gitlin MC (2003) Dexmedetomidine and low-dose ketamine provide adequate sedation for awake fibreoptic intubation. Can J Anaesth 50:607–610

    Article  PubMed  Google Scholar 

  41. Shimabukuro A, Satoh K (2007) Airway management with dexmedetomidine for difficult airway (in Japanese). Masui 56:681–684

    PubMed  Google Scholar 

  42. Siobal MS, Kallet RH, Kivett VA et al (2006) Use of dexmedetomidine to facilitate extubation in surgical intensive-care-unit patients who failed previous weaning attempts following prolonged mechanical ventilation: a pilot study. Respir Care 51:492–496

    PubMed  Google Scholar 

  43. Finkel JC, Quezado ZM (2007) Hypothermia-induced bradycardia in a neonate receiving dexmedetomidine. J Clin Anesth 19:290–292

    Article  PubMed  Google Scholar 

  44. Hammer GB, Drover DR, Cao H et al (2008) The effects of dexmedetomidine on cardiac electrophysiology in children. Anesth Analg 106:79–83

    Article  CAS  PubMed  Google Scholar 

  45. Berkenbosch JW, Tobias JD (2003) Development of bradycardia during sedation with dexmedetomidine in an infant concurrently receiving digoxin. Pediatr Crit Care Med 4:203–205

    Article  PubMed  Google Scholar 

  46. Tobias JD (2007) Dexmedetomidine: applications in pediatric critical care and pediatric anesthesiology. Pediatr Crit Care Med 8:115–131

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Anesthesia, Montreal Children’s Hospital, Montreal, Canada

    Teresa Valois

Authors
  1. Teresa Valois
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Editor information

Editors and Affiliations

  1. Department of Anesthesia and Intensive Care Pediatric Anesthesia and Intensive Care Section, Catania University Hospital, Catania, Italy

    Marinella Astuto MD

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© 2009 Springer-Verlag Italia

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Valois, T. (2009). The Pediatric Difficult Airway. In: Astuto, M. (eds) Basics. Anaesthesia, Intensive Care and Pain in Neonates and Children. Springer, Milano. https://doi.org/10.1007/978-88-470-0655-3_4

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  • DOI: https://doi.org/10.1007/978-88-470-0655-3_4

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-0654-6

  • Online ISBN: 978-88-470-0655-3

  • eBook Packages: MedicineMedicine (R0)

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