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[Airway protection in children with a full stomach]
1Service d'anesthésie-réanimation, hôpital d'enfants Armand-Trousseau, 26, avenue du Docteur-Arnold-Netter, 75571 Paris, France. isabelle.murat@trs.ap-hop-paris.fr
Insights
Pediatric anesthesia carries aspiration risks, especially during emergencies or with bowel obstruction. Using cuffed endotracheal tubes, even in infants, is now more common for airway protection, with specific considerations for cuff size and pressure monitoring.
Area of Science:
- Anesthesiology
- Pediatric Critical Care
- Airway Management
Context:
- Reevaluation of gastric content aspiration risks during pediatric anesthesia.
- Identification of high-risk situations: emergency surgery, bowel obstruction, inadequate anesthesia depth.
- Evolving practice regarding cuffed tracheal tube use in young children and infants.
Purpose:
- To review current understanding and recommendations for managing aspiration risk in pediatric anesthesia.
- To highlight the role of cuffed endotracheal tubes in pediatric airway protection.
- To provide guidance on specific anesthetic techniques, including crash induction.
Summary:
- Cuffed endotracheal tubes, previously deemed unsuitable for children under 6-8 years, are increasingly used for airway protection in pediatric patients, including infants.
- Recommendations include using smaller internal diameter cuffed tubes compared to uncuffed ones and monitoring cuff pressure, especially when nitrous oxide is administered.
- The abstract also addresses pediatric-specific considerations for crash induction procedures.
Impact:
- Informs anesthetic practices to enhance patient safety by mitigating aspiration risks in pediatric populations.
- Supports evidence-based decisions on airway device selection and management in pediatric anesthesia.
- Contributes to improved outcomes for high-risk pediatric surgical and anesthetic procedures.
Abstract:
Recent surveys have reevaluated the risk of aspiration of gastric content during anesthesia in pediatric patients. Emergency, bowel obstruction and inadequate depth of anesthesia are the main high-risk situations. Airway protection requires the placement of cuffed tracheal tube. Cuffed tubes were considered as non-useful in children aged less than 6 to 8 years. They are however more frequently employed even in infants. Internal diameter of cuffed tubes should be reduced compared to uncuffed tubes. It is recommended to monitor cuff pressure if nitrous oxide is used during anesthesia. Crash induction is described with special reference to pediatric specificities.