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Management of the child's airway under anaesthesia: The French guidelines
Christophe Dadure1, Nada Sabourdin2, Francis Veyckemans3
1Département d'anesthesiologie réanimation femme-mère-enfant, CHU de Lapeyronie, institut de génomique fonctionnelle, UMR 5203 CNRS - U 1191 Inserm, université de Montpellier, 34285 Montpellier, France.
Insights
French experts reached strong agreement on 17 guidelines for pediatric anesthesia airway management, covering devices, medications, and patient conditions. These recommendations aim to improve safety in pediatric airway procedures.
Area of Science:
- Anesthesiology
- Pediatric Medicine
- Critical Care
Background:
- Development of French guidelines for "Airway management during paediatric anaesthesia".
- Consensus committee of 17 experts from SFAR and ADARPEF, independent of industry funding.
- Adherence to Grading of Recommendations Assessment, Development and Evaluation (GRADE®) principles for evidence quality assessment.
Framework:
- Focused on 7 key questions: supraglottic airway devices, cuffed endotracheal tubes, videolaryngoscopes, neuromuscular blocking agents, rapid sequence induction, airway device removal, and airway management in children with URTI.
- Utilized Population, Intervention, Comparison, and Outcomes (PICO) framework for evidence analysis.
- Emphasized potential drawbacks of strong recommendations with low-quality evidence.
Implementation:
- Generated 17 statements on pediatric airway management.
- Achieved 100% strong agreement on recommendations after two rounds of discussion.
- Classified recommendations by evidence level: 6 high (Grade 1±), 6 low (Grade 2±), and 5 expert opinions.
Implications:
- Substantial expert consensus achieved on critical aspects of pediatric airway management.
- Provides evidence-based recommendations to enhance safety and standardize care in pediatric anesthesia.
- Highlights areas where recommendations could not be provided due to insufficient evidence.
Objective:
To provide French guidelines about "Airway management during paediatric anaesthesia".
Design:
A consensus committee of 17 experts from the French Society of Anaesthesia and Intensive Care Medicine (Société Française d'Anesthésie-Réanimation, SFAR) and the Association of French speaking paediatric anaesthesiologists and intensivists (Association Des Anesthésistes Réanimateurs Pédiatriques d'Expression Francophone, ADARPEF) was convened. The entire process was conducted independently of any industry funding. The authors followed the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE®) system to assess the quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasised. Few recommendations were not graded.
Methods:
The panel focused on 7 questions: 1) Supraglottic Airway devices 2) Cuffed endotracheal tubes 3) Videolaryngoscopes 4) Neuromuscular blocking agents 5) Rapid sequence induction 6) Airway device removal 7) Airway management in the child with recent or ongoing upper respiratory tract infection. Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. The analysis of the literature and the redaction of the recommendations were then conducted according to the GRADE® methodology.
Results:
The SFAR Guideline panel provides 17 statements on "airway management during paediatric anaesthesia". After two rounds of discussion and various amendments, a strong agreement was reached for 100% of the recommendations. Of these recommendations, 6 have a high level of evidence (Grade 1 ± ), 6 have a low level of evidence (Grade 2 ± ) and 5 are experts' opinions. No recommendation could be provided for 3 questions.
Conclusions:
Substantial agreement exists among experts regarding many strong recommendations for paediatric airway management.