The pediatric airway: Concepts to bear in mind during anesthetic management
Introduction: One of the primary aspects of pediatric anesthesia is airway management. Because of the anatomic differences, this population is more vulnerable to adverse effects produced by the devices designed for their management. Many of the anatomic descriptions are based on knowledge developed mainly as a result of cadaveric dissections. Imaging of the pediatric airway has been available for almost a decade, and it has shown that the glottis is the narrowest portion and that the larynx is more cylindrical than tapered. These findings impact the selection of airway management devices.
Methods:The new anatomic concepts pertaining to the pediatric airway were reviewed, and the advantages and disadvantages of the use of cuffed or uncuffed endotracheal tubes were analyzed.
Results and conclusions: The enhanced knowledge of the pediatric anatomy permits the use of devices suitable to the characteristics of the individual airway. The development of cuffed tubes for pediatric practice is advancing rapidly, although there is no current consensus for their use. However, publications coincide on the need to standardize designs and to measure cuff pressure.
2. Eckenhoff JE. Some anatomic considerations of the infant larynx influencing endotracheal anesthesia. Anesthesiology. 1951;12:401-10.
3. Santillanes G, Gausche-Hill M. Pediatric airway management. Emerg Med Clin North Am. 2008;26:961-75. Review.
4. Bayeux. Tubage de larynx dans le Croup. Presse Med. 1897;20:1.
5. Litman RS, Weissend EE, Shibata D, Westesson PL. Developmental changes of laryngeal dimensions in unparalyzed, sedated children. Anesthesiology. 2003;98:41-5.
6. Miller RD. Textbook of Miller’s anesthesia. Pediatric anesthesia. 6th ed; 2005. p. 2369-70.
7. Dalal PG, Murray D, Messner AH, Feng A, McAllister J, Molter D. Pediatric laryngeal dimensions: an age-based analysis. Anesth Analg. 2009;108:1475-9.
8. Adewale L. Anatomy and assessment of the pediatric airway. Paediatr Anaesth. 2009;19 Suppl. 1:1-8. Review.
9. Uejima T. Cuffed endotracheal tubes in pediatric patients. Anesth Analg. 1989;68:423.
10. Khine HH, Corddry DH, Kettrick RG, Martin TM, McCloskey JJ, Rose JB, et al. Comparison of cuffed and uncuffed endotracheal tubes in young children during general anesthesia. Anesthesiology. 1997;86:627-31, discussion 27A.
11. Pietrini D, Piastra M, Lamperti M, Ingelmo PM. New trends in pediatric anesthesia. Minerva Anestesiol. 2009;75:191-9. Review.
12. Dullenkopf A, Schmitz A, Gerber AC, Weiss M. Tracheal sealing characteristics of pediatric cuffed tracheal tubes. Paediatr Anaesth. 2004;14:825-30.
13. Orliaguet GA, Renaud E, Lejay M, Meyer PG, Schmautz E, Telion C, et al. Postal survey of cuffed or uncuffed tracheal tubes used for paediatric tracheal intubation. Paediatr Anaesth. 2001;11:277-81.
14. Lönnqvist PA. Cuffed or uncuffed tracheal tubes during anaesthesia in infants and small children: time to put the eternal discussion to rest? Br J Anaesth. 2009;103:783-5.
15. Deakers TW, Reynolds G, Stretton M, Newth CJ. Cuffed endotracheal tubes in pediatric intensive care. J Pediatr. 1994;125:57-62.
16. Newth CJ, Rachman B, Patel N, Hammer J. The use of cuffed versus uncuffed endotracheal tubes in pediatric intensive care. J Pediatr. 2004;144:333-7.
17. Weiss M, Dullenkopf A, Gysin C, Dillier CM, Gerber AC. Shortcomings of cuffed paediatric tracheal tubes. Br J Anaesth. 2004;92:78-88.
18. Flynn PE, Black AE, Mitchell V. The use of cuffed tracheal tubes for paediatric tracheal intubation, a survey of specialist practice in the United Kingdom. Eur J Anaesthesiol. 2008;25:685-8.
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