Morrison Christa, Avanis Mary Claire, Ritchie-McLean Susanna, Woo Colleen, Herod Jane, Nandi Reema, Thompson Dominic
Department of Anaesthesia, Great Ormond Street Hospital, London, UK.
Department of Neurosurgery, Great Ormond Street Hospital, London, UK.
Paediatr Anaesth. 2019 Apr;29(4):338-344. doi: 10.1111/pan.13596. Epub 2019 Mar 26.
Craniocervical immobilization using halo body orthoses may be required in the management of children with craniocervical junction pathology. To date, the effect of such immobilization on perioperative anesthetic management has not been addressed in large series.
The aim of this study was to review the airway management of children requiring halo body orthoses undergoing general anesthesia.
The study was a retrospective case note review from a single institution. The neurosurgical database was interrogated to identify all patients less than 16 years of age that required a halo body orthosis from 1996 to 2015. We used the electronic patient record to identify all procedures performed under general anesthesia for these patients, either for halo application, or with the halo in situ. Details of techniques used for airway management were recorded, and paired data between individuals pre- and post-halo application were compared. Demographic data, diagnosis, and perioperative complications were also recorded.
We identified 90 children that underwent placement of a halo body orthosis. A total of 269 anesthetic records from these patients were analyzed and classified as pre-halo application, or halo in situ. Facemask ventilation was achieved in all patients, though some required simple airway adjuncts and may have been more difficult in the presence of the halo. Supraglottic airways were used successfully in many patients. There was a significant increase in the number of patients classed as Cormack and Lehane grades 3 or 4 on direct laryngoscopy with the halo in situ compared with before the halo was applied. The incidence of intubation using fiberoptic or videolaryngoscopy was higher with the halo in situ. Multiple intubation attempts were required in 3.4% (1/29) of patients undergoing anesthesia for halo placement compared with 15.1% (11/73) undergoing anesthesia with a halo in situ.
Airway management in children with cervical spine pathology should be anticipated to be more difficult than the general pediatric population. This is likely to be due to co-existing pathology associated with cervical spine disease in children, limitation of neck movement to prevent further neurological injury, and the halo itself limiting access to the head. We recommend advanced preparation, and ensuring the immediate availability of an anesthetist with skills in managing the pediatric difficult airway to avoid complications in this patient population.
颅颈交界区病变患儿的治疗可能需要使用头环-身体支具进行颅颈固定。迄今为止，此类固定对围手术期麻醉管理的影响尚未在大量病例中得到探讨。
本研究的目的是回顾需要头环-身体支具的患儿在全身麻醉下的气道管理情况。
本研究是对单一机构的病例记录进行回顾性研究。查询神经外科数据库，以确定1996年至2015年间所有年龄小于16岁且需要头环-身体支具的患者。我们使用电子病历识别这些患者在全身麻醉下进行的所有手术，包括头环应用或头环在位时的手术。记录气道管理所使用的技术细节，并比较个体在头环应用前后的配对数据。还记录了人口统计学数据、诊断和围手术期并发症。
我们确定了90名头环-身体支具置入患儿。共分析了这些患者的269份麻醉记录，并分为头环应用前或头环在位。所有患者均成功进行了面罩通气，不过有些患者需要简单的气道辅助工具，且在头环存在的情况下可能更困难。许多患者成功使用了声门上气道。与头环应用前相比，头环在位时直接喉镜检查归类为Cormack和Lehane 3级或4级的患者数量显著增加。头环在位时使用纤维喉镜或视频喉镜插管的发生率更高。头环置入麻醉患者中3.4%（1/29）需要多次插管尝试，而头环在位麻醉患者中这一比例为15.1%（11/73）。
预计颈椎病变患儿的气道管理比一般儿科患者更困难。这可能是由于儿童颈椎疾病相关的并存病变、限制颈部活动以防止进一步神经损伤以及头环本身限制了对头的操作。我们建议进行充分准备，并确保有具备小儿困难气道管理技能的麻醉医生随时待命，以避免该患者群体出现并发症。
