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Published on: January 17, 2011
Delayed Sequence Intubation in Children, Why Not?
Ramón Eizaga Rebollar1, Paula Lozano Hierro1, Ana Mercedes Martínez-Almendros Fernández1
1Department of Anesthesiology and Reanimation, Puerta del Mar University Hospital, Cádiz, Spain\.
Insights
Delayed sequence intubation optimizes pediatric airway management before intubation, reducing hypoxemia risks. This technique is beneficial for uncooperative children, enhancing patient safety during emergency procedures.
Area of Science:
- Pediatric Anesthesiology
- Emergency Medicine
- Airway Management
Background:
- Tracheal intubation in children can rapidly escalate to an emergency.
- Rapid sequence intubation carries a high complication rate, up to 60%.
- Hypoxemia is a primary concern during pediatric intubation.
Purpose of the Study:
- To provide a comprehensive overview of delayed sequence intubation (DSI).
- To define DSI, outline its indications, and review its safety and efficacy.
- To describe anesthetic agents and oxygenation strategies employed in DSI.
Main Methods:
- This narrative review synthesizes current literature on DSI.
- Focuses on techniques involving sedation and oxygenation optimization.
- Examines safety, effectiveness, and complication profiles of DSI.
Main Results:
- Delayed sequence intubation may decrease complications like hypoxemia.
- The technique involves pre-procedure sedation and continuous oxygen therapy.
- It is particularly advantageous in non-cooperative pediatric patients.
Conclusions:
- Delayed sequence intubation offers a safer alternative for pediatric tracheal intubation.
- Optimizing airway and oxygenation prior to induction is key.
- DSI is a valuable technique for managing challenging pediatric airway scenarios.
Abstract:
Tracheal intubation in pediatric patients is a clinical scenario that can quickly become an emergency. Complication rates can potentially reach up to 60% in rapid sequence intubation. An alternate to this is delayed sequence intubation, which may reduce potential complications-mostly hypoxemia-and can be especially useful in non-cooperative children. This technique consists of the prior airway and oxygenation optimization. This is done through sedation using agents that preserve ventilatory function and protective reflexes and continuous oxygen therapy-prior and after the anesthetic induction-using nasal prongs. The objective of this narrative review is to provide a broader perspective on delayed sequence intubation by defining the concept and indications; reviewing its safety, effectiveness, and complications; and describing the anesthetic agents and oxygen therapy techniques used in this procedure.
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