Classical versus controlled rapid sequence induction and intubation in children with bleeding tonsils (a...

Area of Science:

• Pediatric Anesthesiology
• Airway Management
• Surgical Complications

Background:

• Post-tonsillectomy bleeding is a common pediatric surgical emergency requiring prompt airway management.
• Rapid sequence induction and intubation (RSII) is critical, but hypoxemia and difficult laryngoscopy are significant risks.
• The role of bag-mask ventilation during RSII in this specific context remains debated.

Purpose of the Study:

• To evaluate if bag-mask ventilation during RSII for post-tonsillectomy bleeding in children reduces hypoxemia and difficult laryngoscopy.
• To assess if this technique increases perioperative respiratory complications.
• To compare controlled RSII (with bag-mask ventilation) versus classical RSII (apneic technique).

Main Methods:

• Retrospective analysis of medical records and anesthesia data from 2005-2017 for children undergoing revision surgery for tonsil bleeding.
• Categorization of RSII into classical (apneic) or controlled (bag-mask ventilation).
• Primary outcomes included incidence of hypoxemia, laryngoscopy view grade, and intubation difficulty; secondary outcomes were hemodynamic changes and adverse events.

Main Results:

• Controlled RSII was used in 81 children (88 revisions) and classical RSII in 22 children (22 revisions).
• Controlled RSII was associated with significantly less severe hypoxemia (P=.025) and improved laryngoscopy views (P=.048).
• Hypertension was less frequent with controlled RSII (P<.001), with no increase in tracheal intubation difficulties or perioperative pulmonary morbidity.

Conclusions:

• Controlled RSII with bag-mask ventilation offers advantages over classical RSII in children with post-tonsillectomy bleeding.
• This technique may be a strategic option to mitigate hypoxemia, difficult laryngoscopy, and hypertension during anesthesia induction.
• Bag-mask ventilation in this setting did not correlate with increased pulmonary morbidity.