Airway Management Using Supraglottic Airway Device during Glossopexy Surgery for Pierre Robin Sequence

Background Video laryngoscopy is an effective tool in the management of difficult pediatric airway. However, evidence to guide the choice of the most appropriate video laryngoscope (VL) for airway management in pediatric patients with Pierre Robin syndrome (PRS) is insufficient. Therefore, the aim of this study was to compare the efficacy of the Glidescope® Core™ with a hyperangulated blade, the C-MAC® with a nonangulated Miller blade (C-MAC® Miller) and a conventional Miller laryngoscope when used by anesthetists with limited and extensive experience in simulated Pierre Robin sequence. Methods Forty-three anesthetists with limited experience and forty-three anesthetists with extensive experience participated in our randomized crossover manikin trial. Each performed endotracheal intubation with the Glidescope® Core™ with a hyperangulated blade, the C-MAC® with a Miller blade and the conventional Miller laryngoscope. “Time to intubate” was the primary endpoint. Secondary endpoints were “time to vocal cords”, “time to ventilate”, overall success rate, number of intubation attempts and optimization maneuvers, Cormack-Lehane score, severity of dental trauma and subjective impressions. Results Both hyperangulated and nonangulated VLs provided superior intubation conditions. The Glidescope® Core™ enabled the best glottic view, caused the least dental trauma and significantly decreased the “time to vocal cords”. However, the failure rate of intubation was 14% with the Glidescope® Core™, 4.7% with the Miller laryngoscope and only 2.3% with the C-MAC® Miller when used by anesthetists with extensive previous experience. In addition, the “time to intubate”, the “time to ventilate” and the number of optimization maneuvers were significantly increased using the Glidescope® Core™. In the hands of anesthetists with limited previous experience, the failure rate was 11.6% with the Glidescope® Core™ and 7% with the Miller laryngoscope. Using the C-MAC® Miller, the overall success rate increased to 100%. No differences in the “time to intubate” or “time to ventilate” were observed. Conclusions The nonangulated C-MAC® Miller facilitated correct placement of the endotracheal tube and showed the highest overall success rate. Our results therefore suggest that the C-MAC® Miller could be beneficial and may contribute to increased safety in the airway management of infants with PRS when used by anesthetists with limited and extensive experience.

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Airway Management in Children

10.2310/anes.18002 ◽

2019 ◽

Author(s):

James Peyton ◽

Raymond Park

Keyword(s):

Tracheal Intubation ◽

Airway Management ◽

Fiberoptic Bronchoscopy ◽

Difficult Tracheal Intubation ◽

Airway Device ◽

Successful Outcome ◽

Supraglottic Airway ◽

Supraglottic Airway Device ◽

Factors Associated ◽

Life Threatening

Airway management in children is usually very straightforward. Unfortunately, when it is not straightforward complications associated with problems encountered while managing the airway can be life-threatening. Airway management can be considered to consist of several different techniques for oxygenating and ventilating an anesthetized patient, namely mask ventilation, supraglottic airway device ventilation, and tracheal intubation. This chapter discusses these techniques and the factors associated with difficulty in performing them. There are anatomic features associated with difficulty in all of these techniques that are caused by syndromes or abnormal airway anatomy in children, although around 20% of difficult intubations are unanticipated. The majority of complications occur when attempting a difficult tracheal intubation. Morbidity and mortality relating to tracheal intubation correlate to the number of attempts at tracheal intubation. Severe hypoxia is estimated to occur in around 9% of children who are difficult to intubate and hypoxic cardiac arrest in nearly 2%, so the key to successful airway management is to focus on maintaining oxygenation and choosing a technique with the best chance of a successful outcome during the first attempt at airway management. This review contains 6 figures, 7 tables, and 41 references. Keywords: cricothyrotomy, difficult airway, direct laryngoscopy, fiberoptic bronchoscopy, front of neck access, intubation, pediatric, videolaryngoscopy

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Airway management for intubation in newborns with pierre robin sequence

The Laryngoscope ◽

10.1002/lary.23260 ◽

2012 ◽

Vol 122 (6) ◽

pp. 1401-1404 ◽

Cited By ~ 31

Author(s):

Alexander P. Marston ◽

Timothy A. Lander ◽

Robert J. Tibesar ◽

James D. Sidman

Keyword(s):

Airway Management ◽

Pierre Robin Sequence ◽

Robin Sequence ◽

Pierre Robin

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A comprehensive scoring system in correlation with perioperative airway management for neonatal Pierre Robin Sequence

PLoS ONE ◽

10.1371/journal.pone.0189052 ◽

2017 ◽

Vol 12 (12) ◽

pp. e0189052 ◽

Cited By ~ 3

Author(s):

Ning Yin ◽

Lei Fang ◽

Xiaohua Shi ◽

Hongqiang Huang ◽

Li Zhang

Keyword(s):

Airway Management ◽

Scoring System ◽

Pierre Robin Sequence ◽

Robin Sequence ◽

Pierre Robin

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Airway Management for Pierre Robin Sequence: An Anesthetic Challenge

Annals of International medical and Dental Research ◽

10.21276/aimdr.2017.3.2.an3 ◽

2017 ◽

Vol 3 (2) ◽

Author(s):

R. B. Sonwane ◽

Tushar S Patil ◽

Suhas Jewalikar ◽

Sonika Makhija

Keyword(s):

Airway Management ◽

Pierre Robin Sequence ◽

Robin Sequence ◽

Pierre Robin

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Quantification of Mandibular Morphology in Pierre Robin Sequence to Optimize Mandibular Distraction Osteogenesis

The Cleft Palate-Craniofacial Journal ◽

10.1177/1055665620913780 ◽

2020 ◽

Vol 57 (8) ◽

pp. 1032-1040 ◽

Cited By ~ 2

Author(s):

Angela S. Volk ◽

Matthew J. Davis ◽

Amit M. Narawane ◽

Amjed Abu-Ghname ◽

Robert F. Dempsey ◽

...

Keyword(s):

Airway Management ◽

Airway Obstruction ◽

Distraction Osteogenesis ◽

Pierre Robin Sequence ◽

Management Decisions ◽

Mandibular Distraction ◽

Robin Sequence ◽

Mandibular Distraction Osteogenesis ◽

Mandibular Body ◽

Pierre Robin

Background: Mandibular distraction osteogenesis (MDO) is the primary surgical intervention to treat airway obstruction in Pierre Robin sequence (PRS). Current morphologic studies of PRS mandibles do not translate into providing airway management decisions. We compare mandibles of infants with nonsyndromic PRS to controls characterizing morphological variances relevant to distraction. We also examine how morphologic measurements and airway grades correlate with airway management. Methods: Patients with PRS under 2 months old were age and sex matched to controls. Demographic and perioperative data, and Cormack-Lehane airway grades were recorded. Computed tomography scans were used to generate mandibular models. Bilateral condylions, gonions, and the menton were identified. Linear and angular measurements were made. Wilcoxon rank sum and 2-sample t tests were performed. Results: Twenty-four patients with PRS and 24 controls were included. Seventeen patients with PRS required MDO. PRS patients had shorter ramus heights (16.7 vs 17.3 mm; P = .346) and mandibular body lengths (35.3 vs 39.3 mm; P < .001), more acute gonial angles (125.3° vs 131.3°; P < .001), and more obtuse intergonial angles (94.2° vs 80.4°; P < .001) compared to controls. No significant differences were found among patients requiring MDO versus conservative management nor among distracted patients with high versus low airway grades. Conclusion: Our study examines the largest and youngest PRS population to date regarding management of early airway obstruction with MDO. Our findings indicate that univector mandibular body distraction allows for normalization in nonsyndromic patients with PRS, and airway obstruction management decisions should remain clinical.

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