Paediatrics

Paediatrics

 

Learning points
  • Deep removal of the supraglottic airway post tonsillectomy may reduce the incidence of respiratory complications in the recovery period.
  • Uncuffed endotracheal tubes in paediatrics may be on their way out.
  • Difficult intubations are rare in the paediatric population. However, when they occur, careful consideration of backup airway plans must be made bearing in mind that success rate of videolaryngoscopy rescue for children with anticipated difficult laryngoscopy is lower than that observed in adults.
  • Children under 10kg have a lower success rate with both direct laryngoscopy and videolaryngoscopy (Glidescope) than seen in the adult population.
  • As similarly observed in adults, complications in children are associated with multiple attempts at intubation.
  • Aspiration risk is low but devastating in the paediatric population. In addition to respiratory complications, adverse metabolic effects from prolonged starvation can be significant.
  • In a RCT, in apnoeic children, compared with conventional administration of 100 percent oxygen, THRIVE does not seem to effectively extend time to hypoxaemia.
Comments
It cannot be assumed that paediatric patients are just ‘little adults’ and therefore research findings on the adult population should not be simply extrapolated to the paediatric population. The paediatric difficult airway registry (PeDI-R) is a collaborative, multicentre registry created under the auspices of the Society for Paediatric Anaesthesia. Using PeDI-R, Park et al. have demonstrated some differences between adult and paediatric patients in airway management.

References 

  1. De Graaff J.C., Engelhardt T., How big data shape paediatric anaesthesia British Journal of Anaesthesia Sept 2017 119 (3): p. 448-451
  2. Aziz M., Big data, small airways, big problems British Journal of Anaesthesia Nov 2017 119 (5): p. 864-866
  3. Park R. et al., The efficacy of GlideScope® videolaryngoscopy compared with direct laryngoscopy in children who are difficult to intubate: an analysis from the paediatric difficult intubation registry. British Journal of Anaesthesia Nov 2017 119 (5): p. 984-99
  4. Ramgolam et al., Deep or awake removal of laryngeal mask airway in children at risk of respiratory adverse events undergoing tonsillectomy – a randomised controlled trial. British Journal of Anaesthesia Mar 2018 120 (3): p 571-580
  5. Frykholm P. et al., Preoperative fasting in children: review of existing guidelines and recent developments. British Journal of Anaesthesia 120 (3): p 469-474
  6. Aziz M., Big data, small airways, big problems British Journal of Anaesthesia Nov 2017 119 (5): p. 864-866
  7. Bailey C.R., Time to stop using uncuffed tracheal tubes in children? Anaesthesia 73(2)