Department of Anesthesiology Critical Care Medicine, Keck School of Medicine of the University of Southern California, Children's Hospital Los Angeles, Los Angeles, California, USA.
Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, The University of Western Australia.
Curr Opin Anaesthesiol. 2021 Jun 1;34(3):276-283. doi: 10.1097/ACO.0000000000000993.
Children are at risk of severe hypoxemia in the perioperative period owing to their unique anatomy and physiology. Safe and effective airway management strategies are therefore key to the practice of pediatric anesthesia. The goal of this review is to highlight recent publications (2019-2021) aimed to advance pediatric airway safety and to highlight a proposed simple, pediatric-specific, universal framework to guide clinical practice.
Recent investigations demonstrate that infants with normal and difficult airways experience high incidences of multiple laryngoscopy attempts and resulting hypoxemia. Video laryngoscopy may improve tracheal intubation first attempt success rate in infants with normal airways. In infants with difficult airways, standard blade video laryngoscopy is associated with higher first attempt success rates over non-standard blade video laryngoscopy. Recent studies in children with Pierre Robin sequence and mucopolysaccharidoses help guide airway equipment and technique selection. Department airway leads and hospital difficult airway services are necessary to disseminate knowledge, lead quality improvement initiatives, and promote evidence-based practice guidelines.
Pediatric airway management morbidity is a common problem in pediatric anesthesia. Improvements in individual practitioner preparation and management strategies as well as systems-based policies are required. A simple, pediatric-specific, universal airway management framework can be adopted for safe pediatric anesthesia practice.
由于儿童独特的解剖和生理结构，他们在围手术期有发生严重低氧血症的风险。因此，安全有效的气道管理策略是小儿麻醉实践的关键。本文旨在强调近期（2019-2021 年）旨在提高儿科气道安全性的出版物，并提出一个简单、针对儿科的、通用的框架，以指导临床实践。
最近的研究表明，正常和困难气道的婴儿有多次喉镜尝试和低氧血症的高发生率。视频喉镜可提高正常气道婴儿气管插管首次尝试成功率。对于困难气道的婴儿，标准叶片视频喉镜的首次尝试成功率高于非标准叶片视频喉镜。最近对 Pierre Robin 序列和黏多糖贮积症儿童的研究有助于指导气道设备和技术的选择。科室气道负责人和医院困难气道服务是传播知识、领导质量改进计划和促进循证实践指南所必需的。
小儿气道管理并发症是小儿麻醉中的常见问题。需要提高个体从业者的准备和管理策略以及基于系统的政策。一个简单、针对儿科的、通用的气道管理框架可以应用于安全的小儿麻醉实践。
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