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Oropharyngeal airway diameter during sedation in children with and without developmental delay
T Elwood1, L D Hansen, J M Seely
1Department of Anesthesia, Children's Hospital and Regional Medical Center, 4800 Sand Point Way NE, Seattle, WA 98112, USA. telwoo@chmc.org
Insights
Children with developmental delay have narrower upper airways during sedation, increasing their risk of airway obstruction. This study used magnetic resonance imaging (MRI) to compare airway dimensions in sedated children with and without developmental delay.
Area of Science:
- Pediatric medicine
- Anesthesiology
- Radiology
Background:
- Children with developmental delay may have altered upper airway anatomy.
- Upper airway obstruction is a risk during sedation in children.
Purpose of the Study:
- To investigate upper airway dimensions in sedated children with developmental delay.
- To assess if developmental delay is associated with increased risk of airway obstruction.
Main Methods:
- Case-control and retrospective chart review of 40 children (3-6 years old).
- Magnetic resonance imaging (MRI) was used to measure transverse airway diameters at the soft palate and tongue.
- Pentobarbital sedation was administered following a standardized protocol.
Main Results:
- Children with developmental delay had a 40% smaller airway diameter at the soft palate compared to controls (3 mm vs. 5 mm).
- No significant differences were observed in age, weight, sedative dose, or MRI parameters between groups.
- The difference in airway diameter was statistically significant (p = 0.035).
Conclusions:
- Sedated children with developmental delay exhibit smaller oropharyngeal airway diameters.
- These findings suggest a higher risk of upper airway obstruction in this population during sedation.
Study Objective:
To determine whether children with developmental delay would have closer apposition of upper airway tissues during sedation, perhaps because of poor coordination of upper airway musculature.
Design:
Case-control and retrospective chart review.
Setting:
Tertiary-care pediatric teaching hospital.
Patients:
40 children 3 to 6 years of age, with and without a diagnosis of developmental delay.
Measurements:
Subjects received only pentobarbital sedation by a protocol. Magnetic resonance imaging (MRI) scans of the head were reviewed, and transverse airway diameters at the soft palate and tongue were determined from midline sagittal images.
Main Results:
Age, weight, sedative dose, MRI window level, and window width were not different between patients with and without developmental delay. We found the airway diameter at the level of the soft palate was decreased 40% in children with developmental delay compared with those children without delay, 3 mm (1.4, 5.5 interquartile range) versus 5 mm (3, 8); p = 0.035, power 76%.
Conclusions:
The anteroposterior oropharyngeal airway diameter was smaller in children with developmental delay than in those without developmental delay, in static MRI images. It is possible that children with developmental delay are at higher risk for airway obstruction during sedation.
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