Anest. intenziv. Med. 2017;28(2):128-134

Paediatric airway management update: Myths and traditions versus evidence-based medicine (EBM)Review Article

J. Klučka, M. Ťoukálková, I. Křikava, R. Štoudek, P. Štourač*
Klinika dětské anesteziologie a resuscitace, Fakultní nemocnice Brno, Lékařská fakulta Masarykovy univerzity
Brno

Airway management is a critical part of paediatric anaesthesia. Only a minority of anaesthesiologists are experienced in paediatric airway management because of the relatively small number of surgical procedures (compared with the adult population) and also due to the centralization of paediatric medical care. This situation, together with the absence of evidence-based data (EBM) and recommendations often leads to "eminence-based" care (local medical authority experience), which can have negative impact on the final outcome. The author's aim was to analyse and evaluate the current EBM data and recommendations related to paediatric airway management and to discuss the potential controversies - rapid sequence induction and the use of uncuffed versus cuffed tubes in paediatric patients in the perioperative period.

Keywords: airway management; cricoid pressure; Sellicks manoeuvre; rapid sequence induction; paediatric patient; cuffed tracheal tubes

Received: September 29, 2016; Accepted: January 9, 2017; Published: April 1, 2017  Show citation

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Klučka J, Ťoukálková M, Křikava I, Štoudek R, Štourač P. Paediatric airway management update: Myths and traditions versus evidence-based medicine (EBM). Anest. intenziv. Med. 2017;28(2):128-134.
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References

  1. Klučka J, Štourač P, Štoudek R, Ťoukálková M, Harazim H, Kosinová M. Controversies in Pediatric Perioperative Airways. [online] BioMed Research International, Article ID 368761, 2015. doi:10.1155/2015/368761.Dostupný také z www:https://www.hindawi.com/journals/bmri/2015/368761/cta/.
  2. Stept WJ, Safar P. Rapid induction/intubation for prevention of gastric-content aspiration. Anesth Analg. 49, 1970, 633-636. Go to original source...
  3. Snow RG, Nunn RF. Induction of anaesthesia in the foot-down position for patients with a full stomach. Br J Anaesth. 31, 1959, 493-497. Go to original source... Go to PubMed...
  4. El-Orbany M, Connolly L. Rapid sequence induction and intubation: current controversy. Anest Analg., 110, 2010, 1318-1325. Go to original source... Go to PubMed...
  5. Hayes AH, Breslin DS, Mirakhur RK, et al. Frequency of haemoglobin desaturation with the use of succinylcholine during rapid sequence induction of anaesthesia. Acta Anaesthesiol Scand. 45, 2001, 746-749. Go to original source... Go to PubMed...
  6. Heier T, Feiner JR, Lin J, et al. Hemoglobin desaturation after succinylcholine-induced apnea: a study of the recovery of spontaneous ventilation in healthy volunteers. Anesthesiology, 94, 2001, 754-759. Go to original source... Go to PubMed...
  7. Neilipovitz DT, Crosby E T, No evidence for decreased incidence ofaspirationafter rapid sequenceinduction. Can J Anesthes. 54, 2007, 748-764. Go to original source... Go to PubMed...
  8. Cook TM,Woodall N, Frerk C. Fourth National Audit Project of the Royal College of Anaesthetists and Difficult Airway Society. Major Complications of Airway Management in the United Kingdom. Report and Findings. London: Royal College of Anaesthetists, 2011.
  9. Walker RW, Pulmonary aspiration in pediatric anaesthetic practice in the UK: a prospective survey of specialist pediatric centers over a one-year period. Pediatr Anesth. 23, 2013, 702-711. Go to original source... Go to PubMed...
  10. Eich C, Timmermann A, Russo SG, et al. A controlled rapid-sequence induction technique for infants may reduce unsafe actions and stress. Acta Anaesthesiol Scand, 53, 2009, 1167-1172. Go to original source... Go to PubMed...
  11. Zelicof-Paul A, Smith-Lockridge A, Schnadower D, et al. Controversies in rapid sequence intubation in children. Curr Opin Pediatr. 17, 2005, 355-362. Go to original source... Go to PubMed...
  12. Stedeford J, Stoddart P. RSI in pediatric anesthesia - is it used by nonpediatric anesthetists? A survey from south-west England. Pediatr Anesth. 17, 2007, 235-242. Go to original source... Go to PubMed...
  13. Engelhardt T. Rapid sequence induction has no use in pediatric anesthesia. Pediatric Anesthesia, 25, 2015, 201, 5-8. Go to original source... Go to PubMed...
  14. Weiss M, Engelhardt T. Cannot cannulate: bonulate! Eur J Anaesthesiol, 29, 2012, 257-258. Go to original source... Go to PubMed...
  15. Turnbull J, Patel A. Cricoid pressure: The argument against. Trends in Anaesthesia and Critical Care, 5, 2015, 52-56. Go to original source...
  16. Smith K, Ladak S, Choi L, Dobranowski J. The cricoid cartilage and the oesophagus are not aligned in close to half of adult patients. Can J Anaesth. 49, 2002, 5, 503-507. Go to original source... Go to PubMed...
  17. Smith KJ, Dobranowski J, Yip G, Dauphin A, Choi L. Cricoid pressure displaces the esophagus: an observational study using magnetic resonance imaging. Anesthesiology, 99, 2003, 1, 60-64. Go to original source... Go to PubMed...
  18. Zeidan AM, Salem MR, Mazoit JX, Abdullah MA, Ghattas T, Crystal GJ. The effectiveness of cricoid pressure for occluding the esophageal entrance inanesthetized and paralyzed patients: an experimental and observational glidescope study. Anesth Analg. 118, 2014, 3, 80-86. Go to original source... Go to PubMed...
  19. Moynihan RJ, Brock-Utne JG, Archer JH, Feld LH, Kreitzman TR. The effect of cricoid pressure on preventing gastric insufflation in infants and children. Anesthesiology, 78, 1993, s. 652-656. Go to original source... Go to PubMed...
  20. Fourth national audit project. Major complications of airway management in the UK. March 2011. Report and findings of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society.
  21. Mac G, Palmer JH, Ball DR. The effect of cricoids pressure on the cricoids cartilage and vocal cords: an endoscopic study in anaesthetised patients. Anaesthesia, 55, 2000, 263-268. Go to original source... Go to PubMed...
  22. Hartsilver EL, Vanner RG. Airway obstruction with cricoids pressure. Anaesthesia, 55, 2000, 208-211. Go to original source... Go to PubMed...
  23. Levitan RM, Kinkle WC, Levin WJ, Everett WW. Laryngeal view during laryngoscopy: a randomized trial comparing cricoid pressure, backward-upward rightward pressure, and bimanual laryngoscopy. Ann Emerg Med. 47, 2006, 548-55. Go to original source... Go to PubMed...
  24. Garrard A, Campbell AE, Turley A, Hall JE. The effect of mechanically-induced cricoid force on lower oesophageal sphincter pressure in anaesthetized patients. Anaesthesia, 59, 2004, 435-439. Go to original source... Go to PubMed...
  25. Ralph SJ, Wareham CA. Rupture of the oesophagus during cricoid pressure. Anaesthesia, 46, 1991, 40-41. Go to original source... Go to PubMed...
  26. Vanner RG, Pryle BJ. Regurgitation and oesophageal rupture with cricoid pressure: a cadaver study. Anaesthesia, 47, 1992, 732-735. Go to original source... Go to PubMed...
  27. Walton S, Pearce A. Auditing the application of cricoid pressure. Anaesthesia, 55, 2000, 1028-1029. Go to original source... Go to PubMed...
  28. Meek T, Gittins N, Duggan JE. Cricoid pressure: knowledge and performance among anaesthetic assistants. Anaesthesia, 54, 1999, 59-62. Go to original source... Go to PubMed...
  29. Vanner RG. Tolerance of cricoid pressure by conscious volunteers. Int J Obstet Anesth. 1,1992, 195-198. Go to original source... Go to PubMed...
  30. Stewart JC, Bhananker S, Ramaiah R. Rapidsequence intubation and cricoid pressure. Int J Crit Illn Inj Sci. 4, 2014, 42-49. Go to original source... Go to PubMed...
  31. Mittiga MR, Matthew R, et al. A Modern and Practical Reviewof Rapid-Sequence Intubation in Pediatric Emergencies. Clinical Pediatric Emergency Medicine, 16, 2015, 3, 172-185. Go to original source...
  32. Brown JP, Gavin GC, Werrett GC. Bag-maskventilation in rapid sequence induction A survey of current practice among members of the UK Difficult Airway Society. Eur J Anaesthesiol. 32, 2015, 439-450.
  33. Newton R, Hack H. Place of rapid sequence induction in paediatric anaesthesia. BJA Education, 16, 2016, 4, 120-123. Go to original source...
  34. Weiss M, Andreas C, Gerber AC. Rapid sequence induction in children - it's not a matter of time! Pediatric Anesthesia, 18, 2008, 97-99. Go to original source... Go to PubMed...
  35. Weiler N, Heinrichs W, Dick W. Assessment of pulmonary mechanics and gastric inflation pressure during mask ventilation. Prehospital Disaster Med., 10, 1995, 101-105. Go to original source... Go to PubMed...
  36. Zielińska, M., Bartkowska-Śniatkowska, A., Mierzewska-Schmidt M, Cettler M, Kobylarz K, Rawicz M, Piotrowski A. The consensus statement of the Paediatric Section of the Polish Society of Anaesthesiology and Intensive Therapy on general anaesthesia in children over 3 years of age. Part I - general guidelines. Anaesthesiology Intensive Therapy, 48, 2016, 2, 71-78. Go to original source... Go to PubMed...
  37. Fisher DM. Anesthesia equipment for pediatrics. Pediatric Anesthesia. New York: Churchill Livingstone; 1989. 464-5.
  38. Gronert BJ, Motoyama EK. Induction of anesthesia and endotracheal intubation. Smith's Anesthesia for Infants and Children. 6th ed. St. Louis: Mosby; 1996, 281-312.
  39. 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., 25, 2008, 685-688. Go to original source... Go to PubMed...
  40. Hattori S, Ohata H, Dohi S. Bilateral recurrent laryngeal nerve paralysis in a child following a neurosurgical operation. [Article in Japanese]. Masui, 54, 2005, 6, 683-686. Go to PubMed...
  41. Tobias JD. Pediatric airway anatomy may not be what we thought: implications for clinical practice and the use of cuffed endotracheal tubes. Pediatric Anesthesia, 25, 2015, 9-19. Go to original source... Go to PubMed...
  42. Holzki J. Laryngeal damage from tracheal intubation. Paediatr Anaesth., 7, 1997, 435-437. Go to original source... Go to PubMed...
  43. Ho AM, Aun CS, Karmakar MK. The margin of safety associated with the use of cuffed paediatric tracheal tubes. Anesthesia, 57, 2002, 173-175. Go to original source... Go to PubMed...
  44. Al-Metwalli RR, Sadek S. Safety and reliability of the sealing cuff pressure of the Microcuff pediatric tracheal tube for prevention of post-extubation morbidity in children: A comparative study. Saudi J Anaesth., 8, 2014, 484-488. Go to original source... Go to PubMed...
  45. Eschertzhuber S, Salgo B, Schmitz A, Roth W, Frotzler A, Keller CH, Gerber AC, Weiss M. Cuffed endotracheal tubes in children reduce sevoflurane and medical gas consumption and related costs. Acta Anaesthesiol Scand. 54, 2010, 855-858. Go to original source... Go to PubMed...
  46. Gopalareddy V, He Z, Soundar S, Bolling L, Shah M, Penfil S, McCloskey JJ, Mehta DI. Assessment of the prevalence of microaspiration by gastric pepsin in the airway of ventilated children. Acta Paediatr. 97, 2008, 55-60. Go to original source... Go to PubMed...
  47. Litman RS, Maxwell LG. Cuffed versus uncuffed endotracheal tubes in pediatric anesthesia: The debate should finally end. Anesthesiology, 118, 2013, 500-501. Go to original source... Go to PubMed...
  48. Mhamane R, Dave N, Garasia M. Use of Microcuff ® endotracheal tubes in paediatric laparoscopic surgeries. Indian J Anaesth. 59, 2015, 85-88. Go to original source... Go to PubMed...
  49. Mukhopadhyay S, Bhattacharya D, Bandyopadhyay BK, Mukherjee M, Ganguly R. Clinical performance of cuffed versus uncuffed preformed endotracheal tube in pediatric patients undergoing cleft palate surgery. Saudi J Anaesth. 10, 2016, 202-207. Go to original source... Go to PubMed...
  50. Shi F, Xiao Y, Xiong W, Zhou Q, Huang X. Cuffed versus uncuffed endotracheal tubes in children: a meta-analysis. J Anesth. 30, 2016, 3-11. Go to original source... Go to PubMed...
  51. Newth CJ, Rachman B, Patel N, Hammer J. The use of cuffed versus uncuffed endotracheal tubes in pediatric intensive care. Journal of Pediatrics, 144, 2004, 3, 333-337. Go to original source... Go to PubMed...
  52. Tobias JD, Schwartz L, Rice J, Jatana K, Kang DR. Cuffed endotracheal tubes in infants and children: should we routinely measure the cuff pressure? International Journal of Pediatric Otorhinolaryngology, 76, 2012, 1, 61-63. Go to original source... Go to PubMed...
  53. Erb T, Frei FJ. The use of cuffed endotracheal tubes in infants and small children. Anaesthesist, 50, 2001, 395-400. Go to original source... Go to PubMed...
  54. Ramesh S, Jayanthi R, Archana SR. Paediatric airway management: What is new? Indian J Anaesth. 56, 2012, 448-453. Go to original source... Go to PubMed...
  55. Boerboom SL, Muthukrishnan SM, de Graaff JC, Jonker G. Cuffed or uncuffed endotracheal tubes in pediatric anesthesia: a survey of current practice in the United Kingdom and The Netherlands. Pediatric Anesthesia, 25, 2015, 431-439. Go to original source... Go to PubMed...
  56. Dullenkopf A, Schmitz A, Gerber AC, Weiss M. Tracheal sealing characteristics of pediatric cuffed tracheal tubes. Paediatr Anaesth. 14, 2004, 825-830. Go to original source... Go to PubMed...
  57. Dullenkopf A, Gerber AC, Weiss M. Fit and seal characteristics of a new paediatric tracheal tube with high volume-low pressure polyurethane cuff. Acta Anaesthesiol Scand. 49, 2005, 232-237. Go to original source... Go to PubMed...
  58. 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., 11, 2001, 277-281. Go to original source... Go to PubMed...
  59. Weiss M, Dullenkopf A, Fischer JE, Keller C, Gerber AC. Prospective randomized controlled multi-centre trial of cuffed or uncuffed endotracheal tubes in small children. European Paediatric Endotracheal Intubation Study Group. Br J Anaesth. 103, 2009, 867-873. Go to original source... Go to PubMed...
  60. Ortiz AC, Atallah AN, Matos D, da Silva EM. Intravenous versus inhalational anaesthesia for paediatric outpatient surgery. Cochrane Database Syst Rev. 2014; CD009015. doi: 14651858.CD009015.pub2. Go to original source...




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