Karišik Marijana, Janjević Dušanka, Sorbello Massimiliano
Acta Clin Croat. 2016 Mar;55 Suppl 1:51-4.
The primary goal of pediatric airway management is to ensure oxygenation and ventilation. Routine airway management in healthy pediatric patients is normally easy in experienced hands. Really difficult pediatric airway is rare and usually is associated with anatomically and physiologically important findings such as congenital abnormalities and syndromes, trauma, infection, swelling and burns. Using predictors of difficult intubation should be mandatory preoperative assessment in pediatric patients. Difficult airway algorithm for pediatric patients has to consist of three parts: oxygenation (A), tracheal intubation (B), and rescue (C). According to this new algorithm, if conventional direct laryngoscopy fails, we have to use alternative glottic visualization device. Do we really need video laryngoscopy? If we look at numbers, we might estimate that conventional laryngoscopy is successful and effective in around 98.5% of cases. Do we need to replace Macintosh laryngoscope with video laryngoscope completely in our routine practice? Should video laryngoscope be available to replace fiberoptic intubation in pediatric airway management? According to the algorithm, fiberoptic-assisted tracheal intubation combined with extraglottic airway devices is the standard of care. Establishment of protocols for equipping and maintaining airway trolleys and regular training in their use must be provided to avoid tissue hypoxia in children with compromised airway.
小儿气道管理的首要目标是确保氧合和通气。在经验丰富的医护人员手中，健康小儿患者的常规气道管理通常较为容易。真正困难的小儿气道很少见，通常与解剖学和生理学上的重要发现有关，如先天性异常和综合征、创伤、感染、肿胀和烧伤。对于小儿患者，术前必须强制使用困难插管预测指标进行评估。小儿患者的困难气道处理流程必须包括三个部分：氧合（A）、气管插管（B）和救援（C）。根据这一新流程，如果传统直接喉镜检查失败，我们必须使用替代的声门可视化设备。我们真的需要视频喉镜吗？从数据来看，我们可能估计传统喉镜检查在大约98.5%的病例中是成功且有效的。在我们的常规操作中，是否需要完全用视频喉镜取代麦金托什喉镜？在小儿气道管理中，视频喉镜是否应该用于取代纤维光导插管？根据该流程，纤维光导辅助气管插管联合声门外气道装置是标准的治疗方法。必须制定气道推车的配备和维护方案，并定期进行使用培训，以避免气道受损儿童出现组织缺氧。
