Saturday, December 28, 2019

Normal and Difficult Airways in Children: “What’s New”‐ Current Evidence- John Fiadjoe and Akira Nishisaki







Abstract




Background

Pediatric difficult airway is one of the most challenging clinical situations. We will review new concepts and evidence in pediatric normal and difficult airway management in the Operating Room (OR), intensive care unit, Emergency Department, and neonatal intensive care unit.

Methods

Expert review of the recent literature.

Results

Cognitive factors, teamwork and communication play a major role in managing pediatric difficult airway. Earlier studies evaluated video laryngoscopes in a monolithic way yielding inconclusive results regarding their effectiveness. There are however, substantial differences among video laryngoscopes particularly angulated vs. non‐angulated blades which have different learning and use characteristics. Each airway device has strengths and weaknesses, and combining these devices to leverage both strengths will likely yield success. In the Pediatric ICU, ED, and neonatal ICUs, adverse tracheal intubation associated events and hypoxemia are commonly reported. Specific patient, clinician, and practice factors are associated with these occurrences. In both the OR and other clinical areas, use of passive oxygenation will provide additional laryngoscopy time. The use of neuromuscular blockade was thought to be contraindicated in difficult airway patients. Newer evidence from observational studies showed that controlled ventilation with or without neuromuscular blockade is associated with fewer adverse events in the OR. Similarly, a multicenter Neonatal ICU study showed fewer adverse events in infants who received neuromuscular blockade. Neuromuscular blockade should be avoided in patients with mucopolysaccharidosis, head and neck radiation, airway masses, and external airway compression for anticipated worsening airway collapse with neuromuscular blocker administration.

Conclusions

Clinicians caring for children with difficult airways should consider new cognitive paradigms and concepts, leverage the strengths of multiple devices, and consider the role of alternate anesthetic approaches such as controlled ventilation and use of neuromuscular blocking drugs in select situations. Anesthesiologists can partner with ICU, ED, and Neonatology clinicians to improve the safety of airway management in all clinical settings.

Thursday, September 12, 2019

The Concept of "The Army of the Willing." Airway Observer Dr Jack Pacey

Personal Note

It gives me great pleasure to follow the efforts of my wonderful friends in the airway world.
The utility of the video Laryngoscope is now well established but nothing is magic and nothing is so good it cannot be replaced and improved on.

One of my great memories was going to midlevel residents in University teaching hospitals and telling them
Demonstrating the Glidescope ....If you learn how to use this device you will be the "Go To " person in your department for difficult airways and you can build your career on the basis of leading change in airway management.
I would then observe the faculty as they adopted quickly or slowly depending on their attitude towards change. I knew that attitude was the most important quality.

"The Army of the Willing"
This is a phrase which I adopted to determine how long I was prepared to spend educating a potential user. If someone was eager I would spend all day but if they had a poor attitude I would move on to find the willing learner in seconds .
Always spend your maximum teaching effort on the willing potential enthusiast.

Thankfully the Verathon Glidescope team is executing brilliantly on my original vision and also on new ideas that are truly spectacular..



PaceyCuff.com