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Chapter 6 - Oxygenation Techniques for Children with Difficult Airways

from Section 2 - Devices and Techniques to Manage the Abnormal Airway

Published online by Cambridge University Press:  10 September 2019

Narasimhan Jagannathan
Affiliation:
Northwestern University Medical School, Illinois
John E. Fiadjoe
Affiliation:
Children’s Hospital of Philadelphia
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Summary

It is important for the pediatric airway clinician to maintain oxygenation and avoid trauma when managing a child with a difficult airway. While these two objectives are compatible, it is also known that oxygen therapy can lead to significant harm. This chapter will include a discussion of various forms of oxygenation techniques during pediatric airway management, with an emphasis on avoiding hypoxia during all phases of the perioperative process. Included in this discussion will be mention of the deleterious effects of hypoxemia and hyperoxia, and the potential dangers of some oxygenation techniques.

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Publisher: Cambridge University Press
Print publication year: 2019

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References

Bunchungmongkol, N, Somboonviboon, W, Suraseranivongse, S, et al. Pediatric Anesthesia Adverse Events: the Thai Anesthesia Incidents Study (THAI Study) Database of 25  098 cases. Journal of the Medical Association of Thailand 2007; 90: 2072–9.Google Scholar
de Graaff, JC, Bijker, JB, Kappen, TH, et al. Incidence of Intraoperative Hypoxemia in Children in Relation to Age. Anesthesia & Analgesia 2013; 117: 169–75.Google Scholar
Crowley, R, Sanchez, E, Ho, JK, et al. Prolonged Central Venous Desaturation Measured by Continuous Oximetry is Associated with Adverse Outcomes in Pediatric Cardiac Surgery. Anesthesiology 2011; 115: 1033–43.Google Scholar
Gobbo Braz, L, Braz, JRC, MÓDolo, NSP, et al. Perioperative Cardiac Arrest and its Mortality in Children. A 9-Year Survey in a Brazilian Tertiary Teaching Hospital. Pediatric Anesthesia 2006; 16: 860–6.Google Scholar
Morray, JP, Geiduschek, JM, Ramamoorthy, C, et al. Anesthesia-Related Cardiac Arrest in Children: Initial Findings of the Pediatric Perioperative Cardiac Arrest (POCA) Registry. Anesthesiology 2000; 93: 614.CrossRefGoogle ScholarPubMed
van der Walt, J. Oxygen – Elixir of Life or Trojan Horse? Part 2: Oxygen and Neonatal Anesthesia. Paediatric Anaesthesia 2006; 16: 1205–12.Google Scholar
van der Walt, J. Oxygen – Elixir of Life or Trojan Horse? Part 1: Oxygen and Neonatal Resuscitation. Paediatric Anaesthesia 2006; 16: 1107–11.Google Scholar
Tan, A, Schulze, A, O’Donnell, CP, et al. Air versus Oxygen for Resuscitation of Infants at Birth. The Cochrane Database of Systematic Reviews 2005: CD002273.Google Scholar
Vento, M, Moro, M, Escrig, R, et al. Preterm Resuscitation with low Oxygen Causes Less Oxidative Stress, Inflammation, and Chronic Lung Disease. Pediatrics 2009; 124: e439–49.Google Scholar
Naumburg, E, Bellocco, R, Cnattingius, S, et al. Supplementary Oxygen and Risk of Childhood Lymphatic Leukaemia. Acta Paediatrica 2002; 91: 1328–33.Google Scholar
ILOR. The International Liason Committee on Resuscitation Consensus on Science with Treatment Recommendations for Pediatric and Neonatal Patients: Neonatal Resuscitation. Pediatrics 2006; 117: 978–88.Google Scholar
Marcus, RJ, van der Walt, JH, Pettifer, RJ. Pulmonary Volume Recruitment Restores Pulmonary Compliance and Resistance in Anaesthetized Young Children. Paediatric Anaesthesia 2002; 12: 579–84.Google Scholar
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: 251–70.Google Scholar
Frerk, C, Mitchell, VS, McNarry, AF, et al. Difficult Airway Society 2015 Guidelines for Management of Unanticipated Difficult Intubation in Adults. British Journal of Anaesthesia 2015; 115: 827–48.Google Scholar
Law, AJ, Broemling, N, Cooper, RM, et al. The Difficult Airway with Recommendations for Management – Part 2: The Anticipated Difficult Airway. Canadian Journal of Anesthesia/Journal canadien d’anesthésie 2013; 60: 1119–38.Google Scholar
Tanoubi, I, Drolet, P, Donati, F. Optimizing Preoxygenation in Adults. Canadian Journal of Anesthesia/Journal canadien d’anesthésie 2009; 56: 449–66.Google Scholar
Hardman, JG, Wills, JS. The Development of Hypoxaemia during Apnoea in Children: a Computational Modelling Investigation. British Journal of Anaesthesia 2006; 97: 564–70.Google Scholar
Pandit, JJ, Duncan, T, Robbins, PA. Total Oxygen Uptake with Two Maximal Breathing Techniques and the Tidal Volume Breathing Technique: a Physiologic Study of Preoxygenation. Anesthesiology 2003; 99: 841–6.Google Scholar
Weingart, SD, Levitan, RM. Preoxygenation and Prevention of Desaturation during Emergency Airway Management. Annals of Emergency Medicine 2012; 59: 165–75.e161.Google Scholar
Holmdahl, MH. Pulmonary Uptake of Oxygen, Acid-Base Metabolism, and Circulation during Prolonged Apnoea. Acta Chirurgica Scandinavica Supplementum 1956; 212: 1128.Google Scholar
Cook, TM, Wolf, AR, Henderson, AJ. Changes in Blood-Gas Tensions during Apnoeic Oxygenation in Paediatric Patients. British Journal of Anaesthesia 1998; 81: 338–42.Google Scholar
Kernisan, G, Adler, E, Gibbons, P, et al. Apneic Oxygenation in Pediatric Patients. Anesthesiology 1987; 3: A521.Google Scholar
Wung, JT, Stark, RI, Indyk, L, et al. Oxygen Supplement during Endotracheal Intubation of the Infant. Pediatrics 1977; 59(Suppl.): 1046–48.CrossRefGoogle ScholarPubMed
Levitan, RM. (December 9, 2010). NO DESAT! Nasal Oxygen during Efforts Securing a Tube. Emergency Physicians Monthly. Website. http://epmonthly.com/article/no-desat/Google Scholar
Bhagwan, SD. Levitan’s No Desat with Nasal Cannula for Infants with Pyloric Stenosis Requiring Intubation. Paediatric Anaesthesia 2013; 23: 297–8.Google Scholar
Hutchings, FA, Hilliard, TN, Davis, PJ. Heated Humidified High-Flow Nasal Cannula Therapy in Children. Archives of Disease in Childhood 2015; 100: 571–5.Google Scholar
Sreenan, C, Lemke, RP, Hudson-Mason, A, et al. High-Flow Nasal Cannulae in the Management of Apnea of Prematurity: a Comparison with Conventional Nasal Continuous Positive Airway Pressure. Pediatrics 2001; 107: 1081–3.Google Scholar
Patel, A, Nouraei, SA. Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE): a Physiological Method of Increasing Apnoea Time in Patients with Difficult Airways. Anaesthesia 2015; 70: 323–9.Google Scholar
Papoff, P, Luciani, S, Barbara, C, et al. High-Flow Nasal Cannula to Prevent Desaturation in Endotracheal Intubation: a Word of Caution. Critical Care Medicine 2015; 43: e327–8.Google Scholar
Miguel-Montanes, R, Hajage, D, Messika, J, et al. Use of High-Flow Nasal Cannula Oxygen Therapy to Prevent Desaturation during Tracheal Intubation of Intensive Care Patients with Mild-To-Moderate Hypoxemia. Critical Care Medicine 2015; 43: 574–83.Google Scholar
Thomas, JJ, Ciarallo, C. Facemask Ventilation with a Frontonasal Encephalocele. Anesthesiology 2015; 122(3): 698.CrossRefGoogle ScholarPubMed
von Ungern-Sternberg, BS, Erb, TO, Reber, A, et al. Opening the Upper Airway – Airway Maneuvers in Pediatric Anesthesia. Paediatric Anaesthesia 2005; 15: 181–9.Google Scholar
Heinrich, S, Birkholz, T, Ihmsen, H, et al. Incidence and Predictors of Difficult Laryngoscopy in 11 219 Pediatric Anesthesia Procedures. Paediatric Anaesthesia 2012; 22: 729–36.CrossRefGoogle ScholarPubMed
Heinrich, S, Birkholz, T, Ihmsen, H, et al. Incidence and Predictors of Poor Laryngoscopic View in Children Undergoing Pediatric Cardiac Surgery. Journal of Cardiothoracic and Vascular Anesthesia 2013; 27: 516–21.Google Scholar
Hosking, J, Zoanetti, D, Carlyle, A, et al. Anesthesia for Treacher Collins Syndrome: a Review of Airway Management in 240 Pediatric Cases. Paediatric Anaesthesia 2012; 22: 752–8.Google Scholar
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. The Lancet Respiratory Medicine 2016; 4: 3748.CrossRefGoogle ScholarPubMed
Monnier, P. Applied Surgical Anatomy of the Larynx and Trachea. In Monnier, P, ed. Pediatric Airway Surgery. Springer; 2011: 729.Google Scholar
Lopez, U, Habre, W, Laurencon, M, et al. Intra-Operative Awareness in Children: the Value of an Interview Adapted to Their Cognitive Abilities. Anaesthesia 2007; 62: 778–89.CrossRefGoogle ScholarPubMed
Todres, ID, Crone, RK. Experience with a Modified Laryngoscope in Sick Infants. Critical Care Medicine 1981; 9: 544–5.Google Scholar
Steiner, JW, Sessler, DI, Makarova, N, et al. Use of Deep Laryngeal Oxygen Insufflation during Laryngoscopy in Children: a Randomized Clinical Trial. British Journal of Anaesthesia 2016; 117(3): 305–7.Google Scholar
Windpassinger, M, Plattner, O, Gemeiner, J, et al. Pharyngeal Oxygen Insufflation during AirTraq Laryngoscopy Slows Arterial Desaturation in Infants and Small Children. Anesthesia & Analgesia 2016; 122: 1153–7.Google Scholar
Fayoux, P, Marciniak, B, Engelhardt, T. Airway Exchange Catheters Use in the Airway Management of Neonates and Infants Undergoing Surgical Treatment of Laryngeal Stenosis. Pediatric Critical Care Medicine 2009; 10: 558–61.Google Scholar
Willemsen, MG, Noppens, R, Mulder, AL, et al. Ventilation with the Ventrain through a Small Lumen Catheter in the failed paediatric airway: Two Case Reports. British Journal of Anaesthesia 2014; 112: 946–7.Google Scholar
Duggan, LV, Law, JA, Murphy, MF. Brief Review: Supplementing Oxygen through an Airway Exchange Catheter: Efficacy, Complications, and Recommendations. Canadian Journal of Anesthesia/Journal canadien d’anesthésie 2011; 58: 560–8.Google ScholarPubMed
Wise-Faberowski, L, Nargozian, C. Utility of Airway Exchange Catheters in Pediatric Patients with a Known Difficult Airway. Pediatric Critical Care Medicine 2005; 6: 454–6.Google Scholar
Black, AE, Flynn, PE, Smith, HL, et al. Development of a Guideline for the Management of the Unanticipated Difficult Airway in Pediatric Practice. Paediatric Anaesthesia 2015; 25: 346–62.CrossRefGoogle ScholarPubMed
Jagannathan, N, Sequera-Ramos, L, Sohn, L, et al. Elective Use of Supraglottic Airway Devices for Primary Airway Management in Children with Difficult Airways. British Journal of Anaesthesia 2014; 112: 742–8.Google Scholar
Asai, T. Is it Safe to Use Supraglottic Airway in Children with Difficult Airways? British Journal of Anaesthesia 2014; 112: 620–2.Google Scholar
Jagannathan, N, Truong, CT. A Simple Method to Deliver Pharyngeal Anesthesia in Syndromic Infants Prior to Awake Insertion of the Intubating Laryngeal Airway. Canadian Journal of Anesthesia/Journal canadien d’anesthésie 2010; 57: 1138–9.Google Scholar
Badiger, S, John, M, Fearnley, RA, et al. Optimizing Oxygenation and Intubation Conditions during Awake Fibre-Optic Intubation Using a High-Flow Nasal Oxygen-Delivery System. British Journal of Anaesthesia 2015; 115: 629–32.Google Scholar
Holm-Knudsen, R, Eriksen, K, Rasmussen, LS. Using a Nasopharyngeal Airway during Fiberoptic Intubation in Small Children with a Difficult Airway. Paediatric Anaesthesia 2005; 15: 839–45.Google Scholar
Johnson, CM, Sims, C. Awake Fibreoptic Intubation via a Laryngeal Mask in an Infant with Goldenhar’s Syndrome. Anaesthesia & Intensive Care 1994; 22: 194–7.Google Scholar
Huang, AS, Hajduk, J, Jagannathan, N. Advances in Supraglottic Airway Devices for the Management of Difficult Airways in Children. Expert Review of Medical Devices 2016; 13: 157–69.Google Scholar
Baker, PA, Brown, AJ. Experimental Adaptation of the Enk Oxygen Flow Modulator for Potential Pediatric Use. Pediatric Anesthesia 2009; 19: 458–63.Google Scholar
Hamaekers, AE, Borg, PA, Enk, D. A Bench Study of Ventilation via Two Self-Assembled Jet Devices and the Oxygen Flow Modulator in Simulated Upper Airway Obstruction. Anaesthesia 2009; 64: 1353–8.CrossRefGoogle ScholarPubMed
Hooker, EA, Danzl, DF, O’Brien, D, et al. Percutaneous Transtracheal Ventilation: Resuscitation Bags do Not Provide Adequate Ventilation. Prehospital and Disaster Medicine 2006; 21: 431–5.Google Scholar
Sandhya, VV, Chandra, S, Dhanya, MR, et al. Cricothyroidotomy in a Pediatric Patient with Upper Airway Foreign Body. The Airway Gazette 2013; 17: 12.Google Scholar
Paxian, M, Preussler, NP, Reinz, T, et al. Transtracheal Ventilation with a Novel Ejector-Based Device (Ventrain) in Open, Partly Obstructed, or Totally Closed Upper Airways in Pigs. British Journal of Anaesthesia 2015; 115: 308–16.Google Scholar
Sabato, SC, Long, E. An Institutional Approach to the Management of the “Can’t Intubate, Can’t Oxygenate” Emergency in Children. Pediatric Anesthesia 2016; 26: 784–93.Google Scholar
Prunty, SL, Aranda-Palacios, A, Heard, AM, et al. The “Can’t intubate Can’t Oxygenate” Scenario in Pediatric Anesthesia: a Comparison of the Melker Cricothyroidotomy Kit with a Scalpel Bougie Technique. Paediatric Anaesthesia 2015; 25: 400–4.Google Scholar
Stacey, J, Heard, AMB, Chapman, G, et al. The “Can’t Intubate Can’t Oxygenate” Scenario in Pediatric Anesthesia: a Comparison of Different Devices for Needle Cricothyroidotomy. Pediatric Anesthesia 2012; 22: 1155–8.Google Scholar
Norris, MC, Joseph, J, Leighton, BL. Anesthesia for Perinatal Surgery. American Journal of Perinatology 1989; 6: 3940.Google Scholar
Harrison, MR, Adzick, NS, Flake, AW, et al. Correction of Congenital Diaphragmatic Hernia in Utero VIII: Response of the Hypoplastic Lung to Tracheal Occlusion. Journal of Pediatric Surgery 1996; 31: 1339–48.CrossRefGoogle ScholarPubMed
Morris, LM, Lim, FY, Elluru, RG, et al. Severe Micrognathia: Indications for EXIT-to-Airway. Fetal Diagnosis and Therapy 2009; 26: 162–6.Google Scholar
Baker, PA, Aftimos, S, Anderson, BJ. Airway Management during an EXIT Procedure for a Fetus with Dysgnathia Complex. Paediatric Anaesthesia 2004; 14: 781–6.Google Scholar

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