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An ADARPEF survey on respiratory management in pediatric anesthesia
Roselyne Fesseau1, Xavier Alacoque, Claire Larcher
1Department of Anesthesiology and Intensive Care, EA 4564 MATN, IFR 150, Pediatric Unit, University Public Hospital, Toulouse, France.
Insights
Pediatric anesthesia respiratory management varies by age and institution. Practices for preoxygenation, ventilation, and airway devices differ significantly, especially for neonates.
Area of Science:
- Pediatric Anesthesiology
- Respiratory Management
- General Anesthesia
Background:
- Evolving practices in pediatric respiratory management under general anesthesia.
- Need for updated understanding of current anesthetic techniques for children.
Purpose of the Study:
- To survey pediatric anesthetists' practices regarding respiratory management.
- Focus on preoxygenation, breathing systems, ventilation, and airway devices.
- Investigate strategies for short general anesthetics (<30 min) with spontaneous respiration.
Main Methods:
- Online questionnaire distributed to French-speaking Pediatric Anesthetists and Intensivists Association (ADARPEF) members.
- 232 responses analyzed (46% return rate).
Main Results:
- Preoxygenation practices vary, with over 25% not performing it for children <15 years.
- Sevoflurane inhalational induction is preferred (69%).
- Circle systems are common, but Mapleson B is used for neonates; laryngeal mask use increases with age, while endotracheal tubes are reserved for neonates.
Conclusions:
- Pediatric ventilation management is influenced by patient age and institutional type.
- Specific differences in circuit, airway device, and ventilation mode noted for neonates.
- Practices highlight variability in pediatric anesthesia respiratory care.
Background:
There have been recent changes with regard to tools and concepts for respiratory management of children undergoing general anesthesia.
Objectives:
To determine the practice of pediatric anesthetists concerning: preoxygenation, breathing systems, ventilation modes, anesthetic agent and airway device, strategies for a general anaesthetic of less than 30 min using spontaneous respiration, and opinion about technical aspects of ventilation.
Methods:
Online questionnaire sent by e-mail to all the anesthetists registered on the mailing list of the French-speaking Pediatric Anesthetists and Intensivists Association (ADARPEF).
Results:
232 questionnaires (46%) were returned. More than 25% of anesthetists surveyed declared that they do not perform preoxygenation before induction for children <15 years old, apart from neonates and clinical specific situations. When performed, <65% chose a FiO2 higher than 80%. Inhalational induction with sevoflurane is the preferred mode of induction set at 6% or 8%, respectively, 69% [62-75] vs 25% [18-31]. For induction, the circle system was the most popular circuit used in all ages. The accessory breathing system-Mapleson B type-was predominantly used for neonates (44% [37-54]). For maintenance of an anesthesia lasting <30 min in spontaneous breathing, the use of laryngeal mask increased with age, and the endotracheal tube was reserved for neonates (40% [33-48]). Pressure support ventilation was rarely used from the beginning of induction but was widely used for maintenance, whatever the age-group. Results differed according to the type of institution.
Conclusion:
Ventilation management depends on the age and institutions in terms of circuit, airway device or ventilation mode, and specific differences exist for neonates.
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