Assessment and management of the predicted difficult airway in babies and children
Publication date: Available online 31 October 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Paul A Baker, Jamuna Navaratnarajah, Ann E Black Although it is essential to take a history and examine every child prior to airway management, preoperative anticipation of a difficult airway is not totally reliable and therefore it is wise to be prepared for the unexpected difficult airway. Information about the airway can be gained from previous medical records, current history, physical examination and other tests. A natural consequence of airway assessment is development of an airway plan. Important anatomical and physiological features may be identified in an airway assessment which can then have a direct influence on the subsequent airway plan. Managing the predicted difficult airway is usually elective. This allows proper preparation of equipment, assistants, expertise and the environment required for the airway plan. This paper will discuss paediatric airway assessment, outline those features which contribute to airway difficulty, and identify indications and risk factors associated with various airway techniques. Key objectives for an airway management plan are to maintain oxygenation and avoid trauma. This involves adopting techniques that avoid hypoxia and provide a high success rate with minimum attempts.
Conclusionsinstrumental measurements highlight that SLMA offers the advantage of less resistance to the airflow, allowing to keep lower oropharyngeal leak pressure during mechanical ventilation. Despite the differences reported, we observed only a few minor complications in both groups.
Purpose of review The difficult airway remains an ongoing concern in daily anesthesia practice, with awake intubation being an important component of its management. Classically, fiberoptic bronchoscope-assisted tracheal intubation was the method of choice in the awake patient. The development of new generation videolaryngoscopes has revolutionized the approach to tracheal intubation in the anesthetized patient. The question whether videolaryngoscopes have a place in the intubation of the difficult airway in the awake patient is currently being addressed. Recent findings Randomized controlled trials and their meta-ana...
CONCLUSION The Spritztube was as effective as the LMA-S in maintaining the airway with all patients being successfully ventilated without difficulty. The success rate of achieving a patent airway was comparable between the groups, with a similar occurrence of complications. TRIAL REGISTRATION NCT03443219.
BACKGROUND Good visibility is essential for successful laryngeal surgery. A Tritube with outer diameter 4.4 mm, combined with flow-controlled ventilation (FCV), enables ventilation by active expiration with a sealed trachea and may improve laryngeal visibility. OBJECTIVES We hypothesised that a Tritube with FCV would provide better laryngeal visibility and surgical conditions for laryngeal surgery than a conventional microlaryngeal tube (MLT) with volume-controlled ventilation (VCV). DESIGN Randomised, controlled trial. SETTING University Medical Centre. PATIENTS A total of 55 consecutive patients (>18 y...
Publication date: Available online 1 November 2019Source: Operative Techniques in Otolaryngology-Head and Neck SurgeryAuthor(s): Verghese T. Cherian, Sonia J. VaidaAirway management and anesthesia for laryngeal surgery poses many challenges. A preoperative endoscopic airway examination and discussion with the otolaryngologist helps in planning the anesthetic management. Although, securing the airway using specialized endotracheal tubes is possible in the majority of cases, the surgeon may occasionally request a “tubeless” field. This can be achieved by ventilating the lungs using jet ventilation or high flow na...
This article outlines some of the specific difficulties faced by clinicians in ICU and attempts to provide some guidance as to how these may be overcome, or at least abated. Drug and equipment choices are discussed. A suggestion for a difficult airway algorithm for use in the ICU is put forward. The timing of tracheostomy is discussed. Finally, the importance of the team and the human factors that are at play are touched upon.
Abstract A 13-month-old infant was admitted to hospital approximately 3 weeks after ingestion of a button battery, which was lodged in the esophagus and had caused a tracheoesophageal fistula requiring mechanical ventilation. Since the battery had partially penetrated into the tracheal lumen just above the carina and also was in direct contact with the pulmonary artery, extensive considerations regarding airway and circulatory management were required preoperatively, which are presented and discussed in this case report. PMID: 31624891 [PubMed - as supplied by publisher]
Conclusion: Completeness of manual data recording in the electronic AIMS is poor after one year of implementation. First case of the day, second phase of study period, elective cases and trainee anaesthesiologist are associated with better completeness of manual data recording in the AIMS.
Arun Raja Thangavel, Sakthirajan Panneerselvam, Priya Rudingwa, Ranjith Kumar SivakumarIndian Journal of Anaesthesia 2019 63(10):862-863
This study validated a model of slow ‐ and rapid‐airway obstruction that results in significant hypoxia and hypercapnia. This is valuable for future testing of airway device components that may improve airway management. Additionally, our data support the ability of spectral reflectance to differentiate between tracheal and esophag eal tissues in the presence of a clinical condition that decreases oxygen saturation.