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The Pediatric Airway: Anatomy, Challenges, and Solutions

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Pediatric Sedation Outside of the Operating Room

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Abstract

Sedation may alter laryngeal anatomy, function, and respiratory mechanics; therefore, it is essential that the practitioner has a thorough understanding of the pediatric airway. Physical examination reveals the general condition of a patient and the degree of the airway compromise. During sedation, adequate oxygenation and ventilation must be maintained despite a relative decrease in rate and depth of respiration. Conditions that interfere with the integrity of the laryngeal inlet or upper larynx may impair effective ventilation as a result of partial or complete airway obstruction. Sleep-disordered breathing (SDB) is a spectrum of disorders ranging from primary snoring to obstructive sleep apnea syndrome (OSAS). When sedation without a secured airway is planned it is imperative that the level of consciousness, adequacy of ventilation, and oxygenation be continuously monitored and the risk of apnea be evaluated. When a child is sedated, the best prevention is to insure that the position provides the best anatomic orientation for airway patency.

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Notes

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References

  1. O’Connor D. Development anatomy of the larynx and trachea. In: Myer C, Cotton R, Shott S, editors. The pediatric airway an interdisciplinary approch. Philadelphia, PA: JB Lippincott. 1995:1–23.

    Google Scholar 

  2. Litman R, Weissend E, Shibata D, Westesson P. Developmental changes of laryngeal dimensions in unparalyzed sedated children. Anesthesiology. 2003;98(1):41–5.

    Article  PubMed  Google Scholar 

  3. Eckenhoff JE. Some anatomic considerations of the infant larynx influencing endotracheal anesthesia. Anesthesiology. 1951;12(4):401–10.

    Article  PubMed  CAS  Google Scholar 

  4. Plante J, Turgeon AF, Zarychanski R, Lauzier F, Vigneault L, Moore L, et al. Effect of systemic steroids on post-tonsillectomy bleeding and reinterventions: Systematic review and meta-analysis of randomised controlled trials. BMJ. 2012;345:e5389.

    Article  PubMed  PubMed Central  Google Scholar 

  5. McGoldrick K. The larynx: normal development and congenital abnormalities in anesthesia for ophthalmic and otolaryngologic surgery. Philadelphia: WB Saunders Co.; 1992.

    Google Scholar 

  6. Holinger L, Lusk R, Green C, editors. Anatomy in pediatric laryngology & bronchoesophagology. Philadelphia: Lippincott-Raven; 1997.

    Google Scholar 

  7. Katz ES, Mitchell RB, D'Ambrosio CM. Obstructive sleep apnea in infants. Am J Respir Crit Care Med. 2012;185(8):805–16.

    Article  PubMed  Google Scholar 

  8. Hall S. Anesthesia for the neonate. In: Badgewell J, editor. Clinical pediatric anesthesia. Philadelphia: Lippincott-Raven; 1997. p. 163–93.

    Google Scholar 

  9. Samsoon GL, Young JR. Difficult tracheal intubation: a retrospective study. Anaesthesia. 1987;42(5):487–90.

    Article  PubMed  CAS  Google Scholar 

  10. Mallampati SR, Gatt SP, Gugino LD, Desai SP, Waraksa B, Freiberger D, et al. A clinical sign to predict difficult tracheal intubation: a prospective study. Can Anaesth Soc J. 1985;32(4):429–34.

    Article  PubMed  CAS  Google Scholar 

  11. Brodsky L. Modern assessment of tonsils and adenoids. Pediatr Clin North Am. 1989;36:1551–69.

    PubMed  CAS  Google Scholar 

  12. Tsuiki S, Isono S, Ishikawa T, Yamashiro Y, Tatsumi K, Nishino T. Anatomical balance of the upper airway and obstructive sleep apnea. Anesthesiology. 2008;108(6):1009–15.

    Article  PubMed  Google Scholar 

  13. Zalzal GH. Stridor and airway compromise. Pediatr Clin North Am. 1989;36:1389–402.

    PubMed  CAS  Google Scholar 

  14. von Ungern-Sternberg BS, Boda K, Chambers NA, Rebmann C, Johnson C, Sly PD, et al. Risk assessment for respiratory complications in paediatric anaesthesia: a prospective cohort study. Lancet. 2010;376(9743):773–83.

    Article  Google Scholar 

  15. Tait A, Malviva S. Anesthesia for the child with an upper respiratory tract infection is still a dilemma. Anesth Analg. 2005;100:59–65.

    Article  PubMed  Google Scholar 

  16. Steward DJ. Postoperative apnea syndrome in premature infants. West J Med. 1992;157(5):567.

    PubMed  CAS  PubMed Central  Google Scholar 

  17. Cote CJ, Zaslavsky A, Downes JJ, Kurth CD, Welborn LG, Warner LO, et al. Postoperative apnea in former preterm infants after inguinal herniorrhaphy. A combined analysis. Anesthesiology. 1995;82(4):809–22.

    Article  PubMed  CAS  Google Scholar 

  18. Martin LD. Anesthetic implications of an upper respiratory infection in children. Pediatr Clin North Am. 1994;41(1):121–30.

    PubMed  CAS  Google Scholar 

  19. Di Francesco R, Monteiro R, Paulo ML, Buranello F, Imamura R. Craniofacial morphology and sleep apnea in children with obstructed upper airways: differences between genders. Sleep Med. 2012;13(6):616–20.

    Article  PubMed  Google Scholar 

  20. Gozal D, Kheirandish-Gozal L, Bhattacharjee R, Kim J. C-reactive protein and obstructive sleep apnea syndrome in children. Front Biosci (Elite Ed). 2012;4:2410–22.

    Article  Google Scholar 

  21. Lazaratou H, Soldatou A, Dikeos D. Medical comorbidity of sleep disorders in children and adolescents. Curr Opin Psychiatry. 2012;25(5):391–7.

    Article  PubMed  Google Scholar 

  22. Goldstein NA, Stefanov DG, Graw-Panzer KD, Fahmy SA, Fishkin S, Jackson A, et al. Validation of a clinical assessment score for pediatric sleep-disordered breathing. Laryngoscope. 2012;122(9):2096–104.

    Article  PubMed  Google Scholar 

  23. Gasparini G, Saponaro G, Rinaldo FM, Boniello R, Marianetti TM, Torroni A, et al. Clinical evaluation of obstructive sleep apnea in children. J Craniofac Surg. 2012;23(2):387–91.

    Article  PubMed  Google Scholar 

  24. Chung F, Elsaid H. Screening for obstructive sleep apnea before surgery: why is it important? Curr Opin Anaesthesiol. 2009;22(3):405–11.

    Article  PubMed  Google Scholar 

  25. Schwengel DA, Sterni LM, Tunkel DE, Heitmiller ES. Perioperative management of children with obstructive sleep apnea. Anesth Analg. 2009;109(1):60–75.

    Article  PubMed  Google Scholar 

  26. Mehta PP, Kochhar G, Kalra S, Maurer W, Tetzlaff J, Singh G, et al. Can a validated sleep apnea scoring system predict cardiopulmonary events using propofol sedation for routine EGD or colonoscopy? A prospective cohort study. Gastrointest Endosc. 2014;79(3):436–44.

    Article  PubMed  Google Scholar 

  27. Cha JM, Jeun JW, Pack KM, Lee JI, Joo KR, Shin HP, et al. Risk of sedation for diagnostic esophagogastroduodenoscopy in obstructive sleep apnea patients. World J Gastroenterol. 2013;19(29):4745–51.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Brown KA, Laferriere A, Lakheeram I, Moss IR. Recurrent hypoxemia in children is associated with increased analgesic sensitivity to opiates. Anesthesiology. 2006;105(4):665–9.

    Article  PubMed  Google Scholar 

  29. Moss IR, Brown KA, Laferriere A. Recurrent hypoxia in rats during development increases subsequent respiratory sensitivity to fentanyl. Anesthesiology. 2006;105(4):715–8.

    Article  PubMed  Google Scholar 

  30. Hanna AH, Mason LJ. Challenges in paediatric ambulatory anesthesia. Curr Opin Anaesthesiol. 2012;25(3):315–20.

    Article  PubMed  CAS  Google Scholar 

  31. Gross JB, Bachenberg KL, Benumof JL, Caplan RA, Connis RT, Cote CJ, et al. 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. 2006;104(5):1081–93. quiz 1117–1088.

    Article  PubMed  Google Scholar 

  32. Wheeler M. Management strategies for the difficult pediatric airway. Anesthesiol Clin North America. 1998;16(4):743–61.

    Article  Google Scholar 

  33. Haynes SR, Morton NS. The laryngeal mask airway: a review of its use in paediatric anaesthesia. Paediatr Anaesth. 1993;3:65.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA

    Lynne R. Ferrari M.D.

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  1. Lynne R. Ferrari M.D.
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Correspondence to Lynne R. Ferrari M.D. .

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Editors and Affiliations

  1. Department of Anesthesiology, Harvard Medical School, Boston, Massachusetts, USA

    Keira P. Mason

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Ferrari, L.R. (2015). The Pediatric Airway: Anatomy, Challenges, and Solutions. In: Mason, K. (eds) Pediatric Sedation Outside of the Operating Room. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1390-9_7

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  • DOI: https://doi.org/10.1007/978-1-4939-1390-9_7

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  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-1389-3

  • Online ISBN: 978-1-4939-1390-9

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