Hypoxemia, Bradycardia, and Multiple Laryngoscopy Attempts during Anesthetic Induction in Infants A Single-center, Retrospective Study

Editor ’s PerspectiveWhat We Already Know about This TopicSuccessful tracheal intubation of an infant may be a challenging skill to acquire due to differing anatomy and physiology compared to older children and adultsMultiple intubation attempts may be associated with increased complicationsWhat This Article Tells Us That Is NewIn a quaternary pediatric academic center, 16% of healthy infants undergoing routine tracheal intubations had multiple laryngoscopiesThere was also a 35% incidence of hypoxemia, defined as an oxygen saturation measurement less than 90%, during induction of anesthesiaThere was evidence for an association between multiple laryngoscopies and hypoxemiaBackground The infant airway is particularly vulnerable to trauma from repeated laryngoscopy attempts. Complications associated with elective tracheal intubations in anesthetized infants may be underappreciated. We conducted this study of anesthetized infants to determine the incidence of multiple laryngoscopy attempts during routine tracheal intubation and assess the association of laryngoscopy attempts with hypoxemia and bradycardia.Methods We conducted a retrospective cross-sectional cohort study of anesthetized infants (age less than or equal to 12 months) who underwent direct laryngoscopy for oral endotracheal intubation between January 24, 2015, and August 1, 2016. We excluded patients with a history of difficult intubation and emergency procedures. Our primary outcome was the incidence of hypoxem...
Source: Anesthesiology - Category: Anesthesiology Source Type: research

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Conclusion: Our study results show that video-assisted verbal feedback to trainees resulted in high intubation success rate and reduced complications like oesophageal intubation and desaturation in neonatal and infant intubations.
Source: Indian Journal of Anaesthesia - Category: Anesthesiology Authors: Source Type: research
Discussion: Results of the trial could provide insight into influence of lidocaine on local and systemic inflammatory response in cerebrovascular surgery, and might improve future anesthesia practice and treatment outcome. Trial is registered at ClinicalTrials.gov: NCT03823482.
Source: Medicine - Category: Internal Medicine Tags: Research Article: Study Protocol Clinical Trial Source Type: research
DiscussionGVL was safe in our experience and provides unique benefits in selected scenarios in head and neck surgery. Otolaryngologists can consider videolaryngoscopy as a complement to traditional DL.
Source: American Journal of Otolaryngology - Category: Endocrinology Source Type: research
Conclusion: KVVL offers faster intubating conditions for tracheal intubation requiring armored ETTs in comparison to DL using Macintosh blade.
Source: Journal of Anaesthesiology Clinical Pharmacology - Category: Anesthesiology Authors: Source Type: research
(Anesth Analg. 2019;128(3):584–586. Doi:10.1213/ANE.0000000000003886) While video laryngoscopy (VL) has brought substantial changes to the practice of airway management, the way anesthesiologists define a “difficult intubation” has not been altered accordingly. The American Society of Anesthesiologists has defined a “difficult airway” as “the clinical situation in which a conventionally trained anesthesiologist experiences difficulty with facemask ventilation of the upper airway, difficulty with intubation, or both,” and also has set forth clear, separate definitions of difficult ...
Source: Obstetric Anesthesia Digest - Category: Anesthesiology Tags: Editorials and Reviews Source Type: research
This study compares the SALAD and IEI techniques with the tr aditional approach of ad hoc, rigid suction catheter airway decontamination and endotracheal intubation in the setting of massive simulated emesis.Methods: Senior anesthesiology and emergency medicine (EM) residents were randomized into three...
Source: Western Journal of Emergency Medicine - Category: Emergency Medicine Source Type: research
CONCLUSIONS: We showed that a folded towel placed under the shoulders in children younger than two years of age improves glottis visualization, reduces time to intubation and provides ease of use of the C-MAC Miller Video Laryngoscope. Therefore, we think that the placement of a folded towel under the shoulders during the use of a C-MAC Miller Video Laryngoscope may be useful for airway management in children younger than two years of age. This article is protected by copyright. All rights reserved. PMID: 31211460 [PubMed - as supplied by publisher]
Source: Paediatric Anaesthesia - Category: Anesthesiology Authors: Tags: Paediatr Anaesth Source Type: research
An ALS unit is dispatched for an adult patient complaining of severe painful swallowing and difficulty breathing. Upon arrival the patient is acutely decompensating with increasing respiratory effort and diminished color. Supplemental oxygen isn’t providing adequate perfusion. Due to the patient’s rapidly deteriorating condition, the decision is made to intubate. As the laryngoscope is slid beyond the oral cavity, severe epiglottic swelling is visualized. After one intubation attempt the swelling worsens. At this point, endotracheal intubation is not feasible. With no options left, the paramedic resorts to reac...
Source: JEMS Patient Care - Category: Emergency Medicine Authors: Tags: Airway & Respiratory Exclusive Articles Source Type: news
Conclusion: Anesthetists are far more adept in performing ETI in neonates and children compared with pediatricians in a simulated setting. Complications are expected to occur less frequently and less seriously when anesthetists perform ETI.What is Known:•Endotracheal intubation (ETI) performed by inexperienced care providers can lead to unsuccessful and/or prolonged intubation attempts. This can cause complications such as hypoxemia, trauma to the oropharynx and larynx, and prolonged interruption of resuscitation, which results in a high morbidity/mortality.•Fifty to 60 real-life ETI procedures are needed before ...
Source: European Journal of Pediatrics - Category: Pediatrics Source Type: research
This article addresses the uses of videolaryngoscopy, the range of available videolaryngoscopes, the technique of videolaryngoscopy, use of awake videolaryngoscopy and the documentation of videolaryngoscopic intubation.
Source: Trends in Anaesthesia and Critical Care - Category: Anesthesiology Source Type: research
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