Algorithm for difficult airway management in pediatrics
Keywords:
Airway management, Child, Review literature as topic, Algorithms, Intraoperative complications
Abstract
Objective: To describe a series of activities structured for managing the difficult airway in pediatrics and to suggest an algorithm adapted to the individual child's conditions.
Materials and methods: Case review of medical literature databases (PubMed, BIREME and MD consult); the search was based on the following keywords: algorithm, difficult airway, children and pediatrics in articles published during the last 10 years, including topic reviews, systematic reviews or algorithms. The principal authors who reviewed the articles were reviewed. The algorithm design is based on an informal consensus of pediatric anesthesiologists and on the review of all the published literature, in accordance with the availability of resources and the experience in our environment.
Results: The result is a proposal for a simple algorithm including sequential one-way steps for managing the difficult airway in pediatrics. Particular emphasis is placed on situations such as a suspicious airway and a suggestion is made about the equipment and devices required to follow the algorithm. These equipment and devices may be adapted to the particular circumstances of the institution.
Conclusion: This review summarizes the management of the difficult airway in pediatrics and is the first proposal ever submitted in Latin America.
References
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22. Apfelbaum JL, Hagberg CA, Caplan RA, Blitt CD, Connis RT, Nickinovich DG, et al. American Society of Anesthesiologists Task Force on Management of the Difficult Airway 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;118:251-70.
23. Asai T. Videolaryngoscopes: Do they truly have roles in difficult airways? Anesthesiology. 2012;116:515-7.
24. Varghese E1, Nagaraj R, Shwethapriya R. Comparison of oral fiberoptic intubation via a modified Guedel airway or a laryngeal mask airway in infants and children. J Anaesthesiol Clin Pharmacol. 2013;29:52-5.
25. Wrightson F, Soma M, Smith JH. Anesthetic experience of 100 pediatric tracheostomies. Paediatr Anaesth. 2009;19:659-66.
26. Duncan HP, Zurick NJ, Wolf AR. Should we reconsider awake neonatal intubation? A review of the evidence and treatment strategies. Paediatr Anaesth. 2001;11:135-45.
27. Mishra P, Chengode S, Narayanan A, Kausalya R, Kumar S. Utility of LMA for emergency tracheostomy in an infant with Pierre Robin syndrome. Paediatr Anaesth. 2009;19:409-10.
28. Walker RW. The laryngeal mask airway in the difficult paediatric airway: An assessment of positioning and use in fibreoptic intubation. Paediatr Anaesth. 2000;10:53-8.
29. Jöhr M, Berger TM. Fiberoptic intubation through the laryngeal mask airway (LMA) as a standardized procedure. Paediatr Anaesth. 2004;14:614.
30. Loudermilk EP, Hartmannsgruber M, Stoltzfus DP, Langevin PB. A prospective study of the safety of tracheal extubation using a pediatric airway exchange catheter for patients with a known difficult airway. Chest. 1997;111:1660-5.
31. Gencorelli FJ, Fields RG, Litman RS. Complications during rapid sequence induction of general anesthesia in children: a benchmark study. Paediatr Anaesth. 2010;20: 421-4.
32. Neuhaus D, Schmitz A, Gerber A, Weiss M. Controlled rapid sequence induction and intubation - an analysis of 1001 children. Paediatr Anaesth. 2013;23:734-40.
33. Fields RG, Gencorelli FJ, Litman RS. Anesthetic management of the pediatric bleeding tonsil. Paediatr Anaesth. 2010;20:982-6.
34. Eich C, Weiss M, Neuhaus D, Strauss J, Johr M, Becke K. Incidence of complications associated with rapid sequence induction (RSI) in children - it is a matter of age and technique. Paediatr Anaesth. 2010;20:898-9, author reply: 899.
35. Ríos Medina A, Gómez LM, Aguirre O, Ocampo F. La vía aérea pediátrica, algunos conceptos para tener en cuenta en el manejo anestésico. Rev Colomb Anestesiol. 2012;40: 199-202.
2. DeGraaff JC, Kappen TH, Bijker JB, Wolfswinkel L, Klei WA, Kalkman CJ. Intraoperative hypoxemic episodes in children: Incidences obtained from an anesthesia information management system. Anesthesiology. 2011:A567.
3. Sands SA, Edwards BA, Kelly VJ, Davidson MR, Wilkinson MH, Berger PJ. A model analysis of arterial oxygen desaturation during apnea in preterm infants. PLoS Comput Biol. 2009;5:e1000588, doi: 101371/journalpcbi1000588.
4. Hardman JG, Wills JS. The development of hypoxaemia during apnoea in children: A computational modelling investigation. Br J Anaesth. 2006;97:564-70.
5. Tong DC, Beus J, Litman RS. The Children's Hospital of Philadelphia Difficult Intubation Registry. Anesthesiology. 2007;107, 1637A.
6. Karkouti K, Rose DK, Wigglesworth D, Cohen MM. Predicting difficult intubation: A multivariable analysis. Can J Anesth. 2000;47:730-9.
7. Fritscherova S, Adamus M, Dostalova K, Koutna J, Hrabalek L, Zapletalova J, et al. Can difficult intubation be easily and rapidly predicted? Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2011;155:165-72.
8. Infonsino A. Pediatric upper airway and congenital anomalies. Anesthesiology Clin N Am. 2002;20:747-66.
9. Engelhardt T, Machotta A, Weiss M. Management strategies for the difficult paediatric airway. Trends Anaesthesia Critical Care. 2013;3:183-7.
10. Mamie C, Habre W, Delhumeau C, Argiroffo CB, Morabia A. Incidence and risk factors of perioperative respiratory adverse events in children undergoing elective surgery. Paediatr Anaesth. 2004;14:218-24.
11. Murat I, Constant I, Maud'huy H. Perioperative anaesthetic morbidity in children: A database of 24,165 anaesthetics over a 30-month period. Paediatr Anaesth. 2004;14:158-66.
12. Lerman J, Houle TT, Matthews BT, Houck J, Burrows FA. Propofol for tracheal intubation in children anesthetized with sevoflurane: A dose-response study. Paediatr Anaesth. 2009;19:218-24.
13. Nafiu OO, Kheterpal S, Morris M, Reynolds PI, Malviya S, Tremper KK. Incidence and risk factors for preincision hypotension in a noncardiac pediatric surgical population. Paediatr Anaesth. 2009;19:232-9.
14. Weiss M, Engelhardt T. Cannot ventilate - paralyze! Paediatr Anaesth. 2012;22:1147-9.
15. Bennett JA, Abrams JT, van Riper DF, Horrow JC. Difficult or impossible ventilation after sufentanil-induced anesthesia is caused primarily by vocal cord closure. Anesthesiology. 1997;87:1070-4.
16. Holm-Knudsen RJ, Rasmussen LS, Charabi B, Bøttger M, Kristensen MS. Emergency airway access in children - transtracheal cannulas and tracheotomy assessed in a porcine model. Paediatr Anaesth. 2012;22:1159-65.
17. Stacey J, Heard AM, Chapman G, Wallace CJ, Hegarty M, Vijayasekaran S, et al. The 'Can't Intubate Can't Oxygenate' scenario in Pediatric Anesthesia: A comparison of different devices for needle cricothyroidotomy. Paediatr Anaesth. 2012;22:1155-8.
18. Woodall NM, Cook TM. National census of airway management techniques used for anaesthesia in the UK: First phase of the Fourth National Audit Project at the Royal College of Anaesthetists. Br J Anaesth. 2011;106:266-71.
19. Cook TM, Woodall N, Harper J, Benger J. Fourth National Audit Project 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 2: Intensive care and emergency departments. Br J Anaesth. 2011;106:632-42.
20. Lee JH1, Park YH, Byon HJ, Han WK, Kim HS, Kim CS, et al. A comparative trial of the GlideScope® video laryngoscope to direct laryngoscope in children with difficult direct laryngoscopy and an evaluation of the effect of blade size. Anesth Analg. 2013;117:176-81.
21. Van der Griend BF, Lister NA, McKenzie IM, Martin N, Ragg PG, Sheppard SJ, et al. Postoperative mortality in children after 101,885 anesthetics at a tertiary pediatric hospital. Anesth Analg. 2011;112:1440-7.
22. Apfelbaum JL, Hagberg CA, Caplan RA, Blitt CD, Connis RT, Nickinovich DG, et al. American Society of Anesthesiologists Task Force on Management of the Difficult Airway 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;118:251-70.
23. Asai T. Videolaryngoscopes: Do they truly have roles in difficult airways? Anesthesiology. 2012;116:515-7.
24. Varghese E1, Nagaraj R, Shwethapriya R. Comparison of oral fiberoptic intubation via a modified Guedel airway or a laryngeal mask airway in infants and children. J Anaesthesiol Clin Pharmacol. 2013;29:52-5.
25. Wrightson F, Soma M, Smith JH. Anesthetic experience of 100 pediatric tracheostomies. Paediatr Anaesth. 2009;19:659-66.
26. Duncan HP, Zurick NJ, Wolf AR. Should we reconsider awake neonatal intubation? A review of the evidence and treatment strategies. Paediatr Anaesth. 2001;11:135-45.
27. Mishra P, Chengode S, Narayanan A, Kausalya R, Kumar S. Utility of LMA for emergency tracheostomy in an infant with Pierre Robin syndrome. Paediatr Anaesth. 2009;19:409-10.
28. Walker RW. The laryngeal mask airway in the difficult paediatric airway: An assessment of positioning and use in fibreoptic intubation. Paediatr Anaesth. 2000;10:53-8.
29. Jöhr M, Berger TM. Fiberoptic intubation through the laryngeal mask airway (LMA) as a standardized procedure. Paediatr Anaesth. 2004;14:614.
30. Loudermilk EP, Hartmannsgruber M, Stoltzfus DP, Langevin PB. A prospective study of the safety of tracheal extubation using a pediatric airway exchange catheter for patients with a known difficult airway. Chest. 1997;111:1660-5.
31. Gencorelli FJ, Fields RG, Litman RS. Complications during rapid sequence induction of general anesthesia in children: a benchmark study. Paediatr Anaesth. 2010;20: 421-4.
32. Neuhaus D, Schmitz A, Gerber A, Weiss M. Controlled rapid sequence induction and intubation - an analysis of 1001 children. Paediatr Anaesth. 2013;23:734-40.
33. Fields RG, Gencorelli FJ, Litman RS. Anesthetic management of the pediatric bleeding tonsil. Paediatr Anaesth. 2010;20:982-6.
34. Eich C, Weiss M, Neuhaus D, Strauss J, Johr M, Becke K. Incidence of complications associated with rapid sequence induction (RSI) in children - it is a matter of age and technique. Paediatr Anaesth. 2010;20:898-9, author reply: 899.
35. Ríos Medina A, Gómez LM, Aguirre O, Ocampo F. La vía aérea pediátrica, algunos conceptos para tener en cuenta en el manejo anestésico. Rev Colomb Anestesiol. 2012;40: 199-202.
How to Cite
1.
Echeverry Marína PC, Engelhardt T. Algorithm for difficult airway management in pediatrics. Colomb. J. Anesthesiol. [Internet]. 2014 Oct. 1 [cited 2024 Apr. 16];42(4):325-34. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/258
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Published
2014-10-01
How to Cite
1.
Echeverry Marína PC, Engelhardt T. Algorithm for difficult airway management in pediatrics. Colomb. J. Anesthesiol. [Internet]. 2014 Oct. 1 [cited 2024 Apr. 16];42(4):325-34. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/258
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