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Published on: January 17, 2011
Children with limited oral opening can be safely managed without a tracheostomy
1Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota, USA.
Insights
Children with limited oral opening can be safely managed without a tracheostomy, even with frequent anesthesia procedures. This study found no airway compromise in patients over 11 years of follow-up.
Area of Science:
- Pediatric Anesthesiology
- Airway Management
- Critical Care Medicine
Background:
- Limited oral opening presents significant challenges for routine orotracheal intubation in pediatric patients.
- Secure airway management is crucial for children undergoing procedures requiring general anesthesia.
Purpose of the Study:
- To describe airway management strategies for children with limited oral opening precluding direct laryngoscopy.
- To analyze the incidence and outcomes of airway compromise in these patients managed without a tracheostomy.
Main Methods:
- Retrospective case series and chart review of pediatric patients with severe trismus.
- Inclusion criteria: children with limited oral opening unable to undergo routine orotracheal intubation.
- Data collected from 1997 to 2012 at a tertiary children's hospital.
Main Results:
- Ten children (mean age 13 years) underwent 109 procedures without tracheostomy.
- Flexible fiber-optic nasotracheal intubation was the most common method (58 cases).
- No episodes of acute airway compromise resulting in neurologic deficits were observed over 118 patient-years of follow-up.
Conclusions:
- Pediatric patients with limited oral opening can be safely managed without tracheostomy.
- Frequent procedures under general anesthesia are feasible with appropriate airway management techniques.
- This approach minimizes the need for tracheostomy in this challenging patient population.
Objective:
To describe airway management of children with limited oral opening that does not allow for routine orotracheal intubation by direct laryngoscopy. To analyze the incidence and outcome of airway compromise or loss in patients without a tracheostomy in place.
Study Design:
Case series with chart review.
Setting:
Tertiary children's hospital.
Subjects:
Children with limited oral opening that does not allow for routine orotracheal intubation.
Methods:
Children treated at Children's Hospitals and Clinics of Minnesota from 1997 to 2012 with severe trismus were identified and included in the study. Hospital and clinic records were reviewed.
Results:
Ten children (mean age, 13 years; range, 7-17 years) were identified for inclusion into the study. A total of 109 operations requiring general anesthesia (average of 10.9 per patient; range, 0-23) were performed on patients without a tracheostomy in place. Flexible fiber-optic nasotracheal intubation was performed in 58 cases. The remainder of airway control was by mask ventilation (33 cases), various methods of orotracheal intubation (10 cases), unknown (6 cases), and laryngeal mask airway (2 cases). There was a total of 118 patient-years of follow-up without a tracheostomy tube in place (average of 11.8 years per patient). During this period, there were no episodes of acute airway compromise that resulted in neurologic deficits.
Conclusion:
Children with limited oral opening that does not allow for routine orotracheal intubation with direct laryngoscopy may be safely managed without a tracheostomy, even when the child requires frequent procedures under general anesthesia.
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