Templeton T Wesley, Goenaga-Díaz Eduardo J, Runyan Christopher M, Kiell Eleanor P, Lee Amy J, Templeton Leah B
Section on Pediatric Anesthesia, Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina.
Department of Plastic and Reconstructive Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina.
Paediatr Anaesth. 2018 Nov;28(11):1029-1034. doi: 10.1111/pan.13499. Epub 2018 Oct 4.
Airway management in children with Pierre Robin sequence in the infantile period can be challenging and frequently requires specialized approaches.
The aim of this study was to review our experience with a multistage approach to oral and nasal intubation in young infants with Pierre Robin sequence.
After IRB approval, we reviewed 13 infants with Pierre Robin sequence who underwent a multistage approach to intubation in the operating room for mandibular distractor or gastrostomy tube placement. All patients underwent awake placement of either an LMA-Classic™ #1 or ProSeal™ laryngeal mask airway size #1. General anesthesia was induced with sevoflurane, and patients were relaxed with rocuronium. The laryngeal mask airway was replaced with an air-Q 1.0. Children were then intubated through the air-Q 1.0 using a flexible fiberoptic bronchoscope. In cases that required a nasotracheal tube, the oral tube was left in place while a flexible fiberoptic bronchoscope loaded with a similar internal diameter nasal Ring-Adair-Elwyn (RAE) tube was introduced into the nares. Once the scope was in proximity to the glottis, the oral tube was removed and the patient was intubated with the nasal RAE over the fiberscope.
All 13 patients with Pierre Robin sequence were successfully intubated. We observed no periods of desaturation during placement and induction with the LMA-Classic™ or ProSeal™ laryngeal mask airway except in one patient who was in extremis in the neonatal intensive care unit and required emergent transport to the operating room with the laryngeal mask airway in place. We observed several brief periods of desaturation during the apneas associated with fiberoptic intubation.
In conclusion, we were able to use a ventilation-driven, multistaged approach using the unique properties of different supraglottic airways to facilitate oral and nasal intubation in 13 infants with Pierre Robin sequence.
婴儿期患有罗宾序列征的儿童气道管理具有挑战性，通常需要采用特殊方法。
本研究的目的是回顾我们对患有罗宾序列征的小婴儿进行经口和经鼻插管的多阶段方法的经验。
经机构审查委员会（IRB）批准后，我们回顾了13例患有罗宾序列征的婴儿，他们在手术室接受了多阶段插管，用于放置下颌骨牵张器或胃造瘘管。所有患者均在清醒状态下放置1号Classic™喉罩或1号ProSeal™喉罩气道。使用七氟醚诱导全身麻醉，并用罗库溴铵使患者肌肉松弛。将喉罩气道更换为1.0号Air-Q。然后使用可弯曲纤维支气管镜通过1.0号Air-Q对儿童进行插管。在需要经鼻气管插管的情况下，将口插管留在原位，同时将装有内径相似的鼻式Ring-Adair-Elwyn（RAE）管的可弯曲纤维支气管镜插入鼻孔。一旦纤维支气管镜接近声门，就将口插管取出，通过纤维支气管镜用鼻式RAE管对患者进行插管。
13例患有罗宾序列征的患者均成功插管。在使用Classic™喉罩或ProSeal™喉罩气道放置和诱导过程中，除了一名在新生儿重症监护病房处于危急状态且在喉罩气道在位的情况下需要紧急转运至手术室的患者外，我们未观察到任何去饱和期。在与纤维支气管镜插管相关的呼吸暂停期间，我们观察到了几次短暂的去饱和期。
总之，我们能够利用不同声门上气道的独特特性，采用通气驱动的多阶段方法，为13例患有罗宾序列征的婴儿进行经口和经鼻插管。
