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New airway device for ventilation and monitoring in pediatric patients undergoing MRI study
Alexander S Matveevskii1, Mohamed Mahmoud
1Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, ML 2001, Cincinnati, OH 45209, USA. alexander.matveevskii@cchmc.org
Insights
A novel nasal airway device effectively delivers continuous positive airway pressure (CPAP) during anesthesia for pediatric MRI scans, maintaining spontaneous breathing without invasive airways.
Area of Science:
- Anesthesiology
- Pediatric Medicine
- Medical Devices
Background:
- Maintaining spontaneous respiration during anesthesia in pediatric patients undergoing MRI is crucial.
- Traditional methods for airway management can be invasive or insufficient for deep sedation.
- Continuous positive airway pressure (CPAP) can support respiration but requires effective delivery systems.
Purpose of the Study:
- To evaluate the efficacy and safety of a modified nasal vestibule airway (NVA®) for delivering nasal-CPAP in pediatric patients under general anesthesia for MRI.
- To assess the NVA®'s ability to prevent upper airway obstruction and preserve spontaneous respiration.
- To explore the NVA® as an alternative to invasive airways in specific pediatric anesthesia settings.
Main Methods:
- Retrospective study of 45 pediatric patients (5 months to 7 years) undergoing MRI under general anesthesia.
- Anesthesia induced with sevoflurane and maintained with propofol infusion.
- A downsized, pressure-sealing nasal vestibule airway (NVA®) was inserted and connected to a Mapleson F circuit for nasal-CPAP delivery.
- Airway monitoring included capnography, a circuit stethoscope, and a disposable pressure gauge.
Main Results:
- The modified nasal vestibule airway (NVA®) successfully delivered nasal-CPAP during anesthesia for pediatric MRI studies.
- No significant anesthesia-related complications were reported in the 45 patients reviewed.
- The NVA® facilitated airway patency, monitoring, and spontaneous respirations effectively.
- This method avoided the need for invasive airway devices like endotracheal tubes.
Conclusions:
- The modified nasal vestibule airway (NVA®) provides a safe and effective method for delivering nasal-CPAP in pediatric patients undergoing MRI.
- This pressure-sealing nasal cannula offers an alternative to invasive airways, improving airway management and monitoring.
- The NVA® shows potential utility in other pediatric settings where endotracheal intubation is not feasible or necessary.
Abstract:
A method of administering continuous positive airway pressure via a new airway device to prevent upper airway obstruction and preserve spontaneous respiration under total intravenous anesthesia has been adapted for children undergoing deep sedation for MRI studies. Presented herein is a retrospective study of 45 pediatric patients, ages 5 months to 7 years, who underwent an MRI study under general anesthesia using a modified nasal vestibule airway (NVA®), a pressure-sealing nasal cannula that can be used in conjunction with an anesthesia circuit to deliver nasal-CPAP during anesthesia. After inhalation induction of anesthesia with sevoflurane, an intravenous infusion of propofol was used to maintain anesthesia. A NVA®, downsized to fit the nasal vestibule of the child, was inserted, taped in place, and connected to a Mapleson F circuit. An extra long extension of corrugated tubing, a SNOR-SCOPE® circuit stethoscope, and the fluctuations of a reservoir bag allowed monitoring and assisted respirations from the foot of the MRI table. Other monitors included CO2 sampled at the mouth and the fluctuations of a PORTEX® disposable pressure gauge. The records of 45 pediatric patients were reviewed. No significant anesthesia complications were found. A new approach is offered to maintain airway patency, monitoring and spontaneous respirations in pediatric patients undergoing MRI study. This pressure-sealing nasal cannula can deliver CPAP under anesthesia while avoiding the requirement of an invasive airway and facilitating additional monitoring and control not possible with an ordinary nasal cannula. This NVA may be used in other locations in pediatric patients where endotracheal intubation is not necessary or impossible.
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