Abstract
Purpose
To survey Canadian pediatric anesthesiologists to assess practice patterns in managing pediatric patients with difficult airways. Methods: Canadian pediatric anesthesiologists were invited to complete a web survey. Respondents selected their preferred anesthetic and airway management techniques in six clinical scenarios. The clinical scenarios involved airway management for cases where the difficulty was in visualizing the airway, sharing the airway and accessing a compromised airway.
Results
General inhalational anesthesia with spontaneous respiration was the preferred technique for managing difficult intubation especially in infants (90%) and younger children (97%), however, iv anesthesia was chosen for the management of the shared airway in the older child (51 %) where there was little concern regarding difficulty of intubation. Most respondents would initially attempt direct laryngoscopy for the two scenarios of anticipated difficult airway (73% and 98%). The laryngeal mask airway is commonly used to guide fibreoptic endoscopy. The potential for complete airway obstruction would encourage respondents to employ a rigid bron-choscope as an alternate technique (17% and 44%). Conclusion: Inhalational anesthesia remains the preferred technique for management of the difficult pediatric airway amongst Canadian pediatric anesthesiologists. Intravenous techniques are relatively more commonly chosen in cases where there is a shared airway but little concern regarding difficulty of intubation. In cases of anticipated difficult intubation, direct laryngoscopy remains the technique of choice and fibreoptic laryngoscopy makes a good alternate technique. The use of the laryngeal mask airway was preferred to facilitate fibreoptic intubation.
Résumé
Objectif
Mener une enquête auprès des anesthésiologistes canadiens en pédiatrie pour évaluer les modèles de pratique face aux problèmes de voies aériennes.
Méthode
L’enquête a été menée sur le Web. Les répondants ont sélectionné leurs techniques préférées d’anesthésie et de prise en charge des voies aériennes dans six scénarios cliniques dont des cas de visualisation difficile du larynx, de partage des voies aériennes et d’accès à des voies aériennes anormales. Résultats: L’anesthésie générale par inhalation avec respiration spontanée à été préférée pour gérer l’intubation difficile chez les bébés (90 %) et les jeunes enfants (97 %), mais l’anesthésie iv a été choisie en cas de voies aériennes partagées chez les enfants plus âgés (51 %) quand on n’avait pas à se soucier vraiment de difficulté d’intubation. La majorité des répondants essayeraient d’abord la laryngoscopie directe pour les deux scénarios de problèmes anticipés d’intubation (73 % et 98 %). Le masque laryngé sert couramment de guide dans l’endoscopie fibroscopique. La possibilité d’obstruction complète des voies aériennes inciterait les répondants à employer un bronchoscope rigide comme technique de remplacement (17 % et 44%).
Conclusion
L’anesthésie par inhalation demeure la technique préférée de prise en charge des problèmes de voies aériennes chez les enfants par les anesthésiologistes canadiens en pédiatrie. Les techniques intraveineuses sont choisies relativement plus souvent dans les cas de voies aériennes partagées, sans prévision d’intubation difficile. Pour une intubation difficile anticipée, la laryngoscopie directe demeure la technique de choix et la laryngoscopie fibroscopique remplace avantageusement. L’usage du masque laryngé est préféré pour faciliter l’intubation fibroscopique.
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Brooks, P., Ree, R., Rosen, D. et al. Canadian pediatric anesthesiologists prefer inhalational anesthesia to manage difficult airways: A survey. Can J Anesth 52, 285–290 (2005). https://doi.org/10.1007/BF03016065
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DOI: https://doi.org/10.1007/BF03016065