PDF herunterladen
J Pediatr Intensive Care 2018; 07(03): 115-125
DOI: 10.1055/s-0038-1624576
Review Article
Georg Thieme Verlag KG Stuttgart · New York

Management of the Difficult Airway in the Pediatric Patient

Senthil G. Krishna
1   Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, United States
2   Department of Anesthesiology and Pain Medicine, The Ohio State University, Columbus, Ohio, United States
,
Jason F. Bryant
1   Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, United States
2   Department of Anesthesiology and Pain Medicine, The Ohio State University, Columbus, Ohio, United States
,
Joseph D. Tobias
1   Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, United States
2   Department of Anesthesiology and Pain Medicine, The Ohio State University, Columbus, Ohio, United States
3   Department of Pediatrics, The Ohio State University, Columbus, Ohio, United States
› Institutsangaben
Weitere Informationen

Publikationsverlauf

19. Oktober 2017

08. Dezember 2017

Publikationsdatum:
28. Januar 2018 (online)

Auch verfügbar auf
   Lizenzen und Reprints

Abstract

Loss of airway control in children, if not resolved quickly, will lead to devastating consequences. Successful management of the pediatric difficult airway, both anticipated and unanticipated, is facilitated by preprocedure assessment and preparation. Accessibility of and continued hands-on training with modern airway instruments, familiarization with difficult airway guidelines, and collaboration with multidisciplinary airway teams can aid in the management of the difficult pediatric airway. This review outlines the importance of airway assessment and advanced airway equipment for children. It also discusses difficult airway management techniques and algorithms for the management and rescue of the pediatric difficult airway.

Keywords

difficult pediatric airway - ventilation - laryngoscopy
 

  • References

  • 1 Jimenez N, Posner KL, Cheney FW, Caplan RA, Lee LA, Domino KB. An update on pediatric anesthesia liability: a closed claims analysis. Anesth Analg 2007; 104 (01) 147-153
    CrossrefPubMedSuche in Google Scholar
  • 2 Ramamoorthy C, Haberkern CM, Bhananker SM. , et al. Anesthesia-related cardiac arrest in children with heart disease: data from the Pediatric Perioperative Cardiac Arrest (POCA) registry. Anesth Analg 2010; 110 (05) 1376-1382
    CrossrefPubMedSuche in Google Scholar
  • 3 Cook TM, Woodall N, Frerk C. ; 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 1: anaesthesia. Br J Anaesth 2011; 106 (05) 617-631
    CrossrefPubMedSuche in Google Scholar
  • 4 Sunder RA, Haile DT, Farrell PT, Sharma A. Pediatric airway management: current practices and future directions. Paediatr Anaesth 2012; 22 (10) 1008-1015
    CrossrefPubMedSuche in Google Scholar
  • 5 Apfelbaum JL, Hagberg CA, Caplan RA. , 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 (02) 251-270
    CrossrefPubMedSuche in Google Scholar
  • 6 Gonzalez H, Minville V, Delanoue K, Mazerolles M, Concina D, Fourcade O. The importance of increased neck circumference to intubation difficulties in obese patients. Anesth Analg 2008; 106 (04) 1132-1136
    CrossrefPubMedSuche in Google Scholar
  • 7 Santos AP, Mathias LA, Gozzani JL, Watanabe M. Difficult intubation in children: applicability of the Mallampati index [Article in English, Portuguese, Spanish]. Rev Bras Anestesiol 2011; 61 (02) 156-158 , 159–162, 84–87
    CrossrefPubMedSuche in Google Scholar
  • 8 Sheff SR, May MC, Carlisle SE, Kallies KJ, Mathiason MA, Kothari SN. Predictors of a difficult intubation in the bariatric patient: does preoperative body mass index matter?. Surg Obes Relat Dis 2013; 9 (03) 344-349
    CrossrefPubMedSuche in Google Scholar
  • 9 Heinrich S, Birkholz T, Ihmsen H, Irouschek A, Ackermann A, Schmidt J. Incidence and predictors of difficult laryngoscopy in 11,219 pediatric anesthesia procedures. Paediatr Anaesth 2012; 22 (08) 729-736
    CrossrefPubMedSuche in Google Scholar
  • 10 Heinrich S, Birkholz T, Irouschek A, Ackermann A, Schmidt J. Incidences and predictors of difficult laryngoscopy in adult patients undergoing general anesthesia : a single-center analysis of 102,305 cases. J Anesth 2013; 27 (06) 815-821
    CrossrefPubMedSuche in Google Scholar
  • 11 Heinrich S, Ackermann A, Prottengeier J, Castellanos I, Schmidt J, Schüttler J. Increased rate of poor laryngoscopic views in patients scheduled for cardiac surgery versus patients scheduled for general surgery: a propensity score-based analysis of 21,561 cases. J Cardiothorac Vasc Anesth 2015; 29 (06) 1537-1543
    CrossrefPubMedSuche in Google Scholar
  • 12 Butler MG, Hayes BG, Hathaway MM, Begleiter ML. Specific genetic diseases at risk for sedation/anesthesia complications. Anesth Analg 2000; 91 (04) 837-855
    CrossrefPubMedSuche in Google Scholar
  • 13 Uezono S, Holzman RS, Goto T, Nakata Y, Nagata S, Morita S. Prediction of difficult airway in school-aged patients with microtia. Paediatr Anaesth 2001; 11 (04) 409-413
    CrossrefPubMedSuche in Google Scholar
  • 14 Fiadjoe JE, Nishisaki A, Jagannathan N. , et al. Airway management complications in children with difficult tracheal intubation from the Pediatric Difficult Intubation (PeDI) registry: a prospective cohort analysis. Lancet Respir Med 2016; 4 (01) 37-48
    CrossrefPubMedSuche in Google Scholar
  • 15 Jagannathan N, Ramsey MA, White MC, Sohn L. An update on newer pediatric supraglottic airways with recommendations for clinical use. Paediatr Anaesth 2015; 25 (04) 334-345
    CrossrefPubMedSuche in Google Scholar
  • 16 Ramesh S, Jayanthi R. Supraglottic airway devices in children. Indian J Anaesth 2011; 55 (05) 476-482
    CrossrefPubMedSuche in Google Scholar
  • 17 Mathis MR, Haydar B, Taylor EL. , et al. Failure of the Laryngeal Mask Airway Unique™ and Classic™ in the pediatric surgical patient: a study of clinical predictors and outcomes. Anesthesiology 2013; 119 (06) 1284-1295
    CrossrefPubMedSuche in Google Scholar
  • 18 Ramachandran SK, Mathis MR, Tremper KK, Shanks AM, Kheterpal S. Predictors and clinical outcomes from failed Laryngeal Mask Airway Unique™: a study of 15,795 patients. Anesthesiology 2012; 116 (06) 1217-1226
    CrossrefPubMedSuche in Google Scholar
  • 19 Jagannathan N, Sequera-Ramos L, Sohn L, Wallis B, Shertzer A, Schaldenbrand K. Elective use of supraglottic airway devices for primary airway management in children with difficult airways. Br J Anaesth 2014; 112 (04) 742-748
    CrossrefPubMedSuche in Google Scholar
  • 20 Balaban O, Tobias JD. Videolaryngoscopy in neonates, infants, and children. Pediatr Crit Care Med 2017; 18 (05) 477-485
    CrossrefPubMedSuche in Google Scholar
  • 21 Paolini JB, Donati F, Drolet P. Review article: video-laryngoscopy: another tool for difficult intubation or a new paradigm in airway management?. Can J Anaesth 2013; 60 (02) 184-191
    CrossrefPubMedSuche in Google Scholar
  • 22 Pott LM, Murray WB. Review of video laryngoscopy and rigid fiberoptic laryngoscopy. Curr Opin Anaesthesiol 2008; 21 (06) 750-758
    CrossrefPubMedSuche in Google Scholar
  • 23 Holm-Knudsen R. The difficult pediatric airway--a review of new devices for indirect laryngoscopy in children younger than two years of age. Paediatr Anaesth 2011; 21 (02) 98-103
    CrossrefPubMedSuche in Google Scholar
  • 24 Doherty JS, Froom SR, Gildersleve CD. Pediatric laryngoscopes and intubation aids old and new. Paediatr Anaesth 2009; 19 (Suppl. 01) 30-37
    CrossrefPubMedSuche in Google Scholar
  • 25 Liu KP, Li CH, Xue FS. Comparison between the Truview PCD™ or the GlideScope® video laryngoscope and direct laryngoscopy for tracheal intubation in pediatric patients. Can J Anaesth 2013; 60 (07) 735-736
    CrossrefPubMedSuche in Google Scholar
  • 26 Martin LD, Mhyre JM, Shanks Am, Tremper KK, Kheterpal S. 3,423 emergency intubations at a university hospital: airway outcomes and complications. Anesthesiology 2011; 114: 42-48
    CrossrefPubMedSuche in Google Scholar
  • 27 Tobias JD, Tulman DB, Bergese SR. Dexmedetomidine: applications during fiberoptic tracheal intubation of the patient with a difficult airway. ICU Dir 2013; 4: 232-241
    PubMedSuche in Google Scholar
  • 28 Porhomayon J, El-Solh AA, Nader ND. National survey to assess the content and availability of difficult-airway carts in critical-care units in the United States. J Anesth 2010; 24 (05) 811-814
    CrossrefPubMedSuche in Google Scholar
  • 29 Weiss M, Engelhardt T. Proposal for the management of the unexpected difficult pediatric airway. Paediatr Anaesth 2010; 20 (05) 454-464
    CrossrefPubMedSuche in Google Scholar
  • 30 Asai T, Nagata A, Shingu K. Awake tracheal intubation through the laryngeal mask in neonates with upper airway obstruction. PaediatrAnaesth 2008; 18 (01) 77-80
    PubMedSuche in Google Scholar
  • 31 Xue FS, Luo MP, Xu YC, Liao X. Airway anesthesia for awakefiberoptic intubation in management of pediatric difficult airways. Paediatr Anaesth 2008; 18 (12) 1264-1265
    CrossrefPubMedSuche in Google Scholar
  • 32 Black AE, Flynn PE, Smith HL, Thomas ML, Wilkinson KA. ; Association of Pediatric Anaesthetists of Great Britain and Ireland. Development of a guideline for the management of the unanticipated difficult airway in pediatric practice. Paediatr Anaesth 2015; 25 (04) 346-362
    CrossrefPubMedSuche in Google Scholar
  • 33 Orliaguet GA, Gall O, Savoldelli GL, Couloigner V. Case scenario: perianesthetic management of laryngospasm in children. Anesthesiology 2012; 116 (02) 458-471
    CrossrefPubMedSuche in Google Scholar
  • 34 Olsson GL, Hallen B. Laryngospasm during anaesthesia. A computer-aided incidence study in 136,929 patients. Acta Anaesthesiol Scand 1984; 28 (05) 567-575
    CrossrefPubMedSuche in Google Scholar
  • 35 von Ungern-Sternberg BS, Boda K, Chambers NA. , et al. Risk assessment for respiratory complications in paediatric anaesthesia: a prospective cohort study. Lancet 2010; 376 (9743): 773-783
    CrossrefPubMedSuche in Google Scholar
  • 36 Nawfal M, Baraka A. Propofol for relief of extubation laryngospasm. Anaesthesia 2002; 57 (10) 1036-1038
    PubMedSuche in Google Scholar
  • 37 Afshan G, Chohan U, Qamar-Ul-Hoda M, Kamal RS. Is there a role of a small dose of propofol in the treatment of laryngeal spasm?. Paediatr Anaesth 2002; 12 (07) 625-628
    CrossrefPubMedSuche in Google Scholar
  • 38 Hampson-Evans D, Morgan P, Farrar M. Pediatric laryngospasm. Paediatr Anaesth 2008; 18 (04) 303-307
    CrossrefPubMedSuche in Google Scholar
  • 39 Chung DC, Rowbottom SJ. A very small dose of suxamethonium relieves laryngospasm. Anaesthesia 1993; 48 (03) 229-230
    CrossrefPubMedSuche in Google Scholar
  • 40 Liu LM, DeCook TH, Goudsouzian NG, Ryan JF, Liu PL. Dose response to intramuscular succinylcholine in children. Anesthesiology 1981; 55 (05) 599-602
    CrossrefPubMedSuche in Google Scholar
  • 41 Walker RW, Sutton RS. Which port in a storm? Use of suxamethonium without intravenous access for severe laryngospasm. Anaesthesia 2007; 62 (08) 757-759
    CrossrefPubMedSuche in Google Scholar
  • 42 Seah TG, Chin NM. Severe laryngospasm without intravenous access--a case report and literature review of the non-intravenous routes of administration of suxamethonium. Singapore Med J 1998; 39 (07) 328-330
    PubMedSuche in Google Scholar
  • 43 Tobias JD, Nichols DG. Intraosseous succinylcholine for orotracheal intubation. Pediatr Emerg Care 1990; 6 (02) 108-109
    CrossrefPubMedSuche in Google Scholar
  • 44 Cheng CA, Aun CS, Gin T. Comparison of rocuronium and suxamethonium for rapid tracheal intubation in children. Paediatr Anaesth 2002; 12 (02) 140-145
    CrossrefPubMedSuche in Google Scholar
  • 45 Tobias JD. Current evidence for the use of sugammadex in children. Paediatr Anaesth 2017; 27 (02) 118-125
    CrossrefPubMedSuche in Google Scholar
  • 46 Weiss M, Engelhardt T. Cannot ventilate--paralyze!. Paediatr Anaesth 2012; 22 (12) 1147-1149
    CrossrefPubMedSuche in Google Scholar
  • 47 Jagannathan N, Sohn L, Fiadjoe JE. Paediatric difficult airway management: what every anaesthetist should know!. Br J Anaesth 2016; 117 (Suppl. 01) i3-i5
    CrossrefPubMedSuche in Google Scholar
  • 48 Humphreys S, Rosen D, Housden T, Taylor J, Schibler A. Nasal high-flow oxygen delivery in children with abnormal airways. Paediatr Anaesth 2017; 27 (06) 616-620
    CrossrefPubMedSuche in Google Scholar
  • 49 Stacey J, Heard AM, Chapman G. , 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 (12) 1155-1158
    CrossrefPubMedSuche in Google Scholar
  • 50 Coté CJ, Hartnick CJ. Pediatric transtracheal and cricothyrotomy airway devices for emergency use: which are appropriate for infants and children?. Paediatr Anaesth 2009; 19 (Suppl. 01) 66-76
    PubMedSuche in Google Scholar
  • 51 Johansen K, Holm-Knudsen RJ, Charabi B, Kristensen MS, Rasmussen LS. Cannot ventilate-cannot intubate an infant: surgical tracheotomy or transtracheal cannula?. Paediatr Anaesth 2010; 20 (11) 987-993
    CrossrefPubMedSuche in Google Scholar
  • 52 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 (12) 1159-1165
    CrossrefPubMedSuche in Google Scholar
  • 53 Baker PA, Brown AJ. Experimental adaptation of the Enk oxygen flow modulator for potential pediatric use. Paediatr Anaesth 2009; 19 (05) 458-463
    CrossrefPubMedSuche in Google Scholar
  • 54 Kristensen MS. Ultrasonography in the management of the airway. Acta Anaesthesiol Scand 2011; 55 (10) 1155-1173
    CrossrefPubMedSuche in Google Scholar