Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, USA.
Harvard Medical School, Boston, MA, USA.
Paediatr Anaesth. 2020 Mar;30(3):269-279. doi: 10.1111/pan.13814. Epub 2020 Feb 5.
Pediatric patients present unique anatomic and physiologic considerations in airway management, which impose significant physiologic limits on safe apnea time before the onset of hypoxemia and subsequent bradycardia. These issues are even more pronounced for the pediatric difficult airway. In the last decade, the development of pediatric sized supraglottic airways specifically designed for intubation, as well as advances in imaging technology such that current pediatric airway equipment now finally rival those for the adult population, has significantly expanded the pediatric anesthesiologist's tool kit for pediatric airway management. Equally important, techniques are increasingly implemented that maintain oxygen delivery to the lungs, safely extending the time available for pediatric airway management. This review will focus on emerging trends and techniques using existing tools to safely handle the pediatric airway including videolaryngoscopy, combination techniques for intubation, techniques for maintaining oxygenation during intubation, airway management in patients at risk for aspiration, and considerations in cannot intubate cannot oxygenate scenarios.
儿科患者在气道管理方面具有独特的解剖和生理考虑因素，这对安全无通气时间施加了显著的生理限制，以免发生低氧血症和随后的心动过缓。对于儿科困难气道，这些问题更为明显。在过去十年中，专门为插管设计的儿科大小的声门上气道的发展，以及成像技术的进步，使得目前的儿科气道设备终于与成人设备相媲美，这极大地扩展了儿科麻醉师用于儿科气道管理的工具包。同样重要的是，越来越多的技术被实施，以维持向肺部输送氧气，安全地延长儿科气道管理的可用时间。本综述将重点介绍使用现有工具安全处理儿科气道的新兴趋势和技术，包括视频喉镜、插管联合技术、插管期间维持氧合的技术、有吸入风险的患者的气道管理以及无法插管无法供氧情况下的考虑因素。
