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Barrero CE, Pontell ME, Ryan IA, Wietlisbach LE, Wagner CS, Salinero L, Swanson JW, Liao EC, Bartlett SP, Taylor JA. Kaban-Pruzansky Grade Predicts Airway Severity in Hemifacial Microsomia. Plast Reconstr Surg 2024; 153:1359-1366. [PMID: 37257130 DOI: 10.1097/prs.0000000000010785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Children born with hemifacial microsomia (HFM) can experience airway compromise. There is a paucity of data correlating degree of HFM severity with airway difficulty. This study aims to determine the relationship between the degree of micrognathia and airway insufficiency in the HFM population. METHODS Patient demographics, airway function, Kaban-Pruzansky (KP) grade, and Cormack-Lehane (CL) grade were collected and compared with appropriate statistics for HFM patients treated between 2000 and 2022. RESULTS Seventy patients underwent 365 operations with KP grading as follows: 34% KP grade I, 23% KP grade IIA, 11% KP grade IIB, and 33% KP grade III. Goldenhar syndrome was present in 40% of patients and 16% had bilateral disease. KP grade ( P < 0.001) predicted mean number of airway-affecting procedures undergone and difficult airway status ( P < 0.001), with 75% of difficult airways in KP grade III patients. There was no association of airway compromise with Goldenhar syndrome, laterality, or age ( P > 0.05). Most CL grades were I (61%) or IIA (13%), with fewer grade IIB, grade III, and grade IV (4% to 7%). KP grade predicted CL grade ( P < 0.001), with 71% of grade IV views and 64% of grade III views seen in KP grade III patients. CONCLUSIONS KP grade correlated with airway severity in HFM. Patients do not appear to outgrow their CL grade, as previously hypothesized, suggesting that KP grade III patients remain at increased risk for airway insufficiency into the teen years. Given the potential significant morbidity associated with airway compromise, proper identification and preparation for a challenging airway is a critical part of caring for patients with HFM. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.
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Affiliation(s)
- Carlos E Barrero
- From the Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia
| | - Matthew E Pontell
- From the Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia
| | - Isabel A Ryan
- Perelman School of Medicine at the University of Pennsylvania
| | | | - Connor S Wagner
- From the Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia
| | - Lauren Salinero
- From the Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia
| | - Jordan W Swanson
- From the Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia
| | - Eric C Liao
- From the Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia
| | - Scott P Bartlett
- From the Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia
| | - Jesse A Taylor
- From the Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia
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2
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Shen C, Shi Y. The Prevalence of Difficult Airway and Associated Risk Factors in Pediatric Patients: A Cross-sessional Observational Study. J Craniofac Surg 2024; 35:1192-1196. [PMID: 38578083 DOI: 10.1097/scs.0000000000010114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 01/28/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Difficult airway remains a great challenge in pediatric anesthesia practice. Previously published data show the prevalence of difficult airways in pediatric population varies in a wide range. However, there is a lack of studies in the Asian region. METHODS This cross-sectional single-center study was conducted in a tertiary pediatric hospital in China from October 2022 to October 2023. The patients who underwent elective surgery under general anesthesia with tracheal intubation were recruited consecutively. Data on patient characteristics, airway assessment, and airway management information were collected. Multivariable logistic regression analysis was performed to detect the independent variables of difficult airway in pediatric patients. RESULTS A total of 18,491 pediatric patients were included in this study. The overall incidence of difficult airways was 0.22%, 39% of whom were unanticipated. Very few previous airway management information was available in the patients presented with a known difficult airway. Patients with younger age, higher American Society of Anesthesiologists (ASA) physical status classification grade, and presented for craniofacial and thoracic surgery were associated with higher incidence of difficult airway. Further multivariable logistic regression analysis revealed that age ≤28 days (OR=50.48), age between 28days and 1 year (OR=6.053), craniofacial surgery (OR=1.81), and thoracic surgery (OR=0.2465) were independent risk factors of increased incidence of difficult airway. CONCLUSIONS Our study showed the prevalence of difficult airways in pediatric surgical patients. Patient characteristics, age, and type of surgery were identified as the independent factors associated with increased occurrence of difficult airways. Unanticipated difficult airway was not unusual in our study population, even for the patients with previous surgical history.
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Affiliation(s)
- Chen Shen
- Department of Anesthesiology, Children's Hospital of Fudan University, Minhang District, Shanghai, China
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Van Roey VL, Irvine WFE. Optimal Diagnostic and Treatment Practices for Facial Dysostosis Syndromes: A Clinical Consensus Statement Among European Experts. J Craniofac Surg 2024:00001665-990000000-01634. [PMID: 38801252 DOI: 10.1097/scs.0000000000010280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 04/11/2024] [Indexed: 05/29/2024] Open
Abstract
Facial dysostosis syndromes (FDS) are rare congenital conditions impacting facial development, often leading to diverse craniofacial abnormalities. This study addresses the scarcity of evidence on these syndromes about optimal diagnostic and treatment practices. To overcome this scarcity, European experts from ERN CRANIO collaborated to develop a clinical consensus statement through the Delphi consensus method. A systematic search of Embase, MEDLINE/PubMed, Cochrane, and Web of Science databases was conducted until February 2023. The quality of evidence was evaluated using various tools depending on the study design. Statements were subsequently formed based on literature and expert opinion, followed by a Delphi process with expert health care providers and patient representatives. In total, 92 experts from various specialties and three patient representatives were involved in the Delphi process. Over 3 voting rounds, consensus was achieved on 92 (46.9%), 58 (59.2%), and 19 (70.4%) statements, respectively. These statements cover the topics of general care; craniofacial reconstruction; the eyes and lacrimal system; upper airway management; genetics; hearing; speech; growth, feeding, and swallowing; dental treatment and orthodontics; extracranial anomalies; and psychology and cognition. The current clinical consensus statement provides valuable insights into optimal diagnostic and treatment practices and identifies key research opportunities for FDS. This consensus statement represents a significant advancement in FDS care, underlining the commitment of health care professionals to improve the understanding and management of these rare syndromes in Europe.
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Affiliation(s)
- Victor L Van Roey
- Department of Plastic and Reconstructive Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- European Reference Network for Rare and/or Complex Craniofacial Anomalies and Ear, Nose, and Throat Disorders, Rotterdam, The Netherlands
| | - Willemijn F E Irvine
- Department of Pediatric Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Evidence-Based Medicine and Methodology, Qualicura Healthcare Support Agency, Breda, The Netherlands
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4
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Hunyady AI, Sergeeva V, Kovatsis PG, Evans KN, Staffa SJ, Zurakowski D, Fiadjoe JE, Jimenez N. Difficult intubation in syndromic versus nonsyndromic forms of micrognathia in children. Acta Anaesthesiol Scand 2024; 68:466-475. [PMID: 38164092 DOI: 10.1111/aas.14369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/27/2023] [Accepted: 12/03/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND We investigated how syndromic versus nonsyndromic forms of micrognathia impacted difficult intubation outcomes in children. Primary outcome was the first-attempt success rate of tracheal intubation, secondary outcomes were number of intubation attempts and complications. We hypothesized that syndromic micrognathia would be associated with lower first-attempt success rate. METHODS In micrognathic patients enrolled in the Pediatric Difficult Intubation Registry (08/2012-03/2019) we retrospectively compared demographic and clinical characteristics between children with nonsyndromic and syndromic micrognathia using standardized mean differences (SMD) and assessed the association of the presence of syndrome with the primary and secondary outcomes using propensity score matching analysis with and without matching for airway assessment findings. RESULTS Nonsyndromic patients (628) were less likely to have additional airway abnormalities. Syndromic patients (216) were less likely to have unanticipated difficult intubation (2% vs. 20%, SMD 0.59). First-attempt success rates of intubation were: 38% in the syndromic versus 34% in the nonsyndromic group (odds ratio [OR] 1.18; 95% confidence intervals [95% CI] 0.74, 1.89; p = .478), and 37% versus 37% (OR 0.99; 95% CI 0.66, 1.48; p = .959). Median number of intubation attempts were 2 (interquartile range [IQR]: 1, 3; range: 1, 8) versus 2 (IQR: 1, 3; range 1, 12) (median regression coefficient = 0; 95% CI: -0.7, 0.7; p = .999) and 2 (IQR: 1, 3; range: 1, 12) versus 2 (IQR: 1, 3; range 1, 8) (median regression coefficient = 0; 95% CI: -0.5, 0.5; p = .999). Complication rates were 14% versus 22% (OR 0.6; 95% CI 0.34, 1.04; p = .07) and 16% versus 21% (OR 0.71; 95% CI 0.43, 1.17; p = .185). CONCLUSIONS Presence of syndrome was not associated with lower first-attempt success rate on intubation, number of intubation attempts, or complication rate among micrognathic patients difficult to intubate, despite more associated craniofacial abnormalities. Nonsyndromic patients were more likely to have unanticipated difficult intubations, first attempt with direct laryngoscopy.
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Affiliation(s)
- Agnes I Hunyady
- Department of Anesthesiology and Pain Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, USA
| | - Vera Sergeeva
- Department of Anesthesia and Critical Care Kursk Regional Perinatal Center, Kursk State Medical University, Kursk, Russia
| | - Pete G Kovatsis
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kelly N Evans
- Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, USA
| | - Steven J Staffa
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - David Zurakowski
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - John E Fiadjoe
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nathalia Jimenez
- Department of Anesthesiology and Pain Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, USA
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5
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Barrero CE, Wietlisbach LE, Pontell ME, Salinero LK, Wagner CS, Swanson JW, Bartlett SP, Taylor JA. Severity of Mandibular Dysmorphology in Treacher Collins Syndrome for Stratification of Perioperative Airway Risk. J Craniofac Surg 2024; 35:18-22. [PMID: 37646339 DOI: 10.1097/scs.0000000000009700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 07/12/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Patients with Treacher Collins syndrome (TCS) and attendant airway dysmorphology may be predisposed to airway complications in the perioperative period. However, limited data correlates severity of mandibular hypoplasia and airway status. This study aims to improve risk stratification for perioperative airway insufficiency in TCS by using a previously proposed mandibular severity index. METHODS Patient demographics, perioperative airway status, difficulty of intubation, and Cormack Lehane grade were collected and compared using a TCS mandibular hypoplasia severity grading scale in patients with TCS treated between 2000 and 2022. RESULTS Twenty-six patients underwent 222 procedures with institutional mandibular severity gradings as follows: 23% Grade I, 31% Grade II, 39% Grade III, 8% Grade IV. Our severity index was associated with intubation difficulty ( P <0.001) and difficult airway status ( P <0.001), with 72% of difficult airways found in grade III and grade IV patients. Mandibular retrusion and ramal hypoplasia subscores were positively correlated with measures of airway severity ( P <0.001), whereas the gonial angle was negatively correlated ( P <0.001). Age was negatively correlated with difficult visualization for endotracheal intubation ( P =0.02) but had no association with difficult airway status ( P =0.2). CONCLUSIONS This study found a positive correlation between severity of maxillomandibular dysmorphology and perioperative airway difficulty in TCS patients. Our findings suggest that severely affected patients require heightened vigilance throughout life, as difficult airways may not completely resolve with aging. Given the risk of morbidity and mortality associated with airway complications, proper identification and preparation for challenging airways is critical for TCS patients.
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Affiliation(s)
- Carlos E Barrero
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, PA
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Saito Y, Chaki T, Nishihara N, Yamakage M. A case of monosomy 21 presented with difficult tracheal intubation. JA Clin Rep 2022; 8:24. [PMID: 35333987 PMCID: PMC8956749 DOI: 10.1186/s40981-022-00511-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 03/05/2022] [Accepted: 03/07/2022] [Indexed: 05/31/2023] Open
Abstract
Background Monosomy 21 is a rare chromosomal abnormality. It is mainly associated with mental retardation, intellectual disability, growth retardation, microcephaly, and characteristic facial features. General anesthesia in adults with this disease has not been reported. We report difficult airway management of an adult patient with monosomy 21. Case description A 30-year-old female was scheduled for laparoscopic gynecological surgery. She was diagnosed with monosomy 21 at birth and accompanied with mental retardation. Preoperative examination revealed limited mouth opening with Mallampati score of IV, but no abnormal laboratory test or chest X-P. Anesthesia was performed using general anesthesia with epidural analgesia. Although bag-mask ventilation was improved by a muscle relaxant, mouth opening was further restricted, and laryngoscope insertion was impossible. Tracheal intubation was achieved using a bronchofiberscope. The operation procedure was completed, and the patient was discharged from the hospital without any major postoperative complications. Conclusions In this patient, mouth opening was further reduced after induction of general anesthesia with a muscle relaxant. Preoperative evaluation and adequate preparation of airway management are important for general anesthesia in an adult patient with monosomy 21.
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Affiliation(s)
- Yoshiki Saito
- Department of Anesthesiology, Sapporo Medical University School of Medicine, 291, South 1, West 16, Chuo-ku, Sapporo, Hokkaido, Japan.
| | - Tomohiro Chaki
- Department of Anesthesiology, Sapporo Medical University School of Medicine, 291, South 1, West 16, Chuo-ku, Sapporo, Hokkaido, Japan
| | - Noriaki Nishihara
- Department of Anesthesiology, Sapporo Medical University School of Medicine, 291, South 1, West 16, Chuo-ku, Sapporo, Hokkaido, Japan
| | - Michiaki Yamakage
- Department of Anesthesiology, Sapporo Medical University School of Medicine, 291, South 1, West 16, Chuo-ku, Sapporo, Hokkaido, Japan
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7
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Theroux MC, Campbell JW. Anesthetic Concerns of Children With Skeletal Dysplasia. Neurosurg Clin N Am 2021; 33:37-47. [PMID: 34801140 DOI: 10.1016/j.nec.2021.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Children with skeletal dysplasia present unique challenges for safe anesthetic care including differences in the anatomy of the respiratory system, possibility of cervical spine instability or spinal stenosis, and a unique body habitus. Even seemly routine anesthesia can result in respiratory arrest or spinal cord injury. These complications can largely be avoided by proper planning such as appropriate techniques for the intubation of difficult airways, recognition of cervical instability, neuromonitoring for any anesthesia over an hour in patients with severe spinal stenosis, and preoperative assessment of the trachea and avoidance of neuraxial anesthesia in children with Morquio syndrome.
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Affiliation(s)
- Mary C Theroux
- Department of Anesthesia, Nemours/AI duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE 19803, USA
| | - Jeffrey W Campbell
- Division of Pediatric Neurosurgery, Nemours/AI duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE 19803, USA.
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8
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Mohan S, Del Rosario TJ, Pruett BE, Heard JA. Anesthetic Management of Treacher Collins Syndrome in an Outpatient Surgical Center. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e931974. [PMID: 34480792 PMCID: PMC8428621 DOI: 10.12659/ajcr.931974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Patient: Male, 15-year-old
Final Diagnosis: Treacher Collins syndrome
Symptoms: Difficult airway management
Medication:—
Clinical Procedure: —
Specialty: Anesthesiology
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Affiliation(s)
- Sanjay Mohan
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Timothy J Del Rosario
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Brandon E Pruett
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jarrett A Heard
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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9
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Developmental features and predicting airway failure risk in critically ill children with mandibular hypoplasia using 3D computational tomographic analysis. Sci Rep 2021; 11:9881. [PMID: 33972643 PMCID: PMC8110979 DOI: 10.1038/s41598-021-89302-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 04/23/2021] [Indexed: 11/22/2022] Open
Abstract
In children with mandibular hypoplasia, airway management is challenging. However, detailed cephalometric assessment data for this population are sparse. The aim of this study was to find risk factors for predicting difficult airways in children with mandibular hypoplasia, and compare upper airway anatomical differences using three-dimensional computed tomography (3D CT) between children with mandibular hypoplasia and demographically matched healthy controls. There were significant discrepancies in relative tongue position (P < 0.01) and anterior distance of the hyoid bone (P < 0.01) between patients with mandibular hypoplasia and healthy controls. All mandibular measures were significantly different between the two groups, except for the height of the ramus of the mandible. After adjusting for age and sex, the anterior distance of hyoid bone and inferior pogonial angle were significantly associated with a difficult airway (P = 0.01 and P = 0.02). Quantitative analysis of upper airway structures revealed significant discrepancies, including relative tongue position, hyoid distance, and mandible measures between patients with mandibular hypoplasia and healthy controls. The anterior distance of the hyoid bone and inferior pogonial angle may be risk factors for a difficult airway in patients with mandibular hypoplasia.
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10
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Cheng JZ, Wang J. Negative Pressure Pulmonary Edema Related to Laryngospasm and Upper Airway Obstruction in a Patient With Treacher Collins Syndrome. Cureus 2021; 13:e14426. [PMID: 34079650 PMCID: PMC8159308 DOI: 10.7759/cureus.14426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Laryngospasm is an uncommon complication of anesthesia in adults but more common in pediatric anesthesia, which could present similarly to supraglottic upper airway obstruction. The management of such airway complications is even more difficult in patients with difficult mask ventilation and intubation. Our case illustrated the management of laryngospasm and negative pressure pulmonary edema in a patient with Treacher Collins syndrome. A literature search revealed few previous similar reports. We demonstrated an algorithm to differentiate between the true laryngospasm from the supraglottic upper airway obstruction, the management of laryngospasm in patients with difficult airways, and the recognition and management of negative pressure pulmonary edema as a complication of laryngospasm.
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Affiliation(s)
- Jenny Zhao Cheng
- Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, USA.,Anesthesia, Harvard Medical School, Boston, USA
| | - Jingping Wang
- Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, USA.,Anesthesia, Harvard Medical School, Boston, USA
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11
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Reid L, Carroll W. Treacher Collins Syndrome in the United States: Examining Incidence and Inpatient Interventions. Cleft Palate Craniofac J 2021; 58:1438-1442. [PMID: 33784859 DOI: 10.1177/1055665621998138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Advancements have been made in the care of patients with Treacher Collins syndrome (TCS), but epidemiological data are lacking given its rarity. A national database provides a valuable opportunity for studying the incidence of rare craniofacial conditions. We sought to evaluate disease incidence of phenotypically severe cases and the frequency of the most common associated diagnoses and interventions. DESIGN The 2016 Kids' Inpatient Database (KID), Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality was the first version to include updated International Classification of Diseases-Tenth Edition (ICD-10) coding encompassing a unique code for TCS. The 2016 KID was queried for the unique code. Incidence was calculated using national estimates. Diagnosis and procedure codes were pooled and analyzed. PATIENTS A total of 266 discharge cases with a diagnosis code for TCS (Q75.4). MAIN OUTCOMES Disease incidence and the most frequent diagnosis and procedure codes. RESULTS The estimated incidence of children born with a diagnosis of TCS was approximately 1 in 80,000. Two of the three most common ICD-10 diagnosis codes were tracheostomy status and obstructive sleep apnea. The most common procedures performed were airway examination procedures. CONCLUSIONS Treacher Collins syndrome is a rare craniofacial disorder requiring complex multidisciplinary management. Phenotypically severe cases requiring inpatient management may be rarer than previous estimates suggest. Inpatient airway interventions are very common, and multidisciplinary team members should anticipate the degree of potential airway risk these patients pose.
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Affiliation(s)
- Lauren Reid
- Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - William Carroll
- Department of Otolaryngology-Head and Neck Surgery, Augusta University Health, Augusta, GA, USA.,Medical College of Georgia at Augusta University, Augusta, GA, USA
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12
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Siddiqui KM, Ali MA, Salim B. Transversus abdominis plane block as a sole anesthetic technique for open appendectomy in patient with Treacher Collins syndrome: a case report. J Surg Case Rep 2020; 2020:rjaa431. [PMID: 33343860 PMCID: PMC7732257 DOI: 10.1093/jscr/rjaa431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 10/19/2020] [Indexed: 11/13/2022] Open
Abstract
Patients with Treacher Collins syndrome (TCS) present serious challenges to anesthetist in securing of airway; upper airway obstruction and difficult tracheal intubation are considered complex entity in these patients. This case report describes the significance of transversus abdominis plane (TAP) block as a sole anesthetic choice in appendectomy where airway management can be avoided. A 17-year-old boy, known case of TCS, presented with acute appendicitis underwent emergency laparotomy. Surgery was successfully performed by TAP block with dexmedetomidine infusion. Open appendectomy can be performed successfully in certain circumstances under TAP block with adjunctive use of dexmedetomidine infusion where airway handling is avoided. Further studies are warranted to distinct its use as sole anesthetic choice in lower abdominal surgeries.
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Affiliation(s)
| | - Muhammad Asghar Ali
- Department of Anesthesiology, Aga Khan University Hospital, Karachi, Pakistan
| | - Bushra Salim
- Department of Anesthesiology, Aga Khan University Hospital, Karachi, Pakistan
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13
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Heninger J, Phillips M, Huang A, Jagannathan N. Management of the Difficult Pediatric Airway. CURRENT ANESTHESIOLOGY REPORTS 2020. [DOI: 10.1007/s40140-020-00408-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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14
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134 Cases of Airway Management in Treacher Collins Syndrome: A Single-Institution, 27-Year Experience. Plast Reconstr Surg 2020; 146:514e-515e. [PMID: 32649594 DOI: 10.1097/prs.0000000000007189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Perez FA, Hottinger DG, Evans KN, Giles M, Otto RK, Hunyady A, Gentry KR. Longer upper airway lengths in Robin Sequence: A case-control study using computed tomography. Paediatr Anaesth 2020; 30:683-690. [PMID: 32277728 DOI: 10.1111/pan.13869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 02/29/2020] [Accepted: 03/23/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Direct laryngoscopy and intubation are often difficult in children with Robin Sequence. Previous research characterizing anatomic airway differences has focused on parameters influencing airway patency; there is a paucity of data pertaining to intubation trajectories and depth. Such information could impact airway management approaches and decrease the incidence of endotracheal tube malpositioning. AIM The study goal was to examine whether longitudinal airway parameters pertaining to intubation are different in children with Robin Sequence compared with age-matched controls. METHOD This case-control study compared patients with RS <4 years of age who had computed tomography scans of the head and neck to age- and sex-matched controls. Measurements were made of the nasopharynx, oropharynx, hypopharynx, tongue, hyoid, and the front teeth to vocal cord, nares to vocal cord, and nasion-basion distances. Statistical analysis was performed using multiple ANCOVA models with the categorical predictor of Robin Sequence vs control and potential covariates including subject height/length, weight, and age. RESULTS Thirty-three patients with Robin Sequence and 33 control subjects were included. After controlling for subject height/length, mean front teeth to vocal cord distance was 1.2 cm longer (95% CI: 0.9 to 1.6 cm, P < .001) and mean nares to vocal cord distance was 0.8 cm longer (95% CI: 0.4 to 1.2 cm, P < .001) in patients with Robin Sequence than in controls. The tongue was positioned on average 0.5 cm higher (95% CI: 0.3 to 0.8, P < .001) and 0.9 cm more posterior (95% CI: 0.6 to 1.0 cm, P < .001) in cases than in controls. Moreover, in patients with Robin Sequence, the hyoid was positioned on average 0.5 cm more inferiorly (95% CI: 0.2 to 0.8 cm, P < .001) and 0.2 cm more posteriorly (95% CI: 0.1 to 0.4 cm, P < .01) than controls. CONCLUSION In patients with Robin Sequence under 4 years of age, the mean front teeth to vocal cord distance was found to be 1.2 cm longer while the mean nares to vocal cord distance was found to be 0.8 cm longer controlling for subject length. Clinicians should account for these differences when selecting and placing endotracheal tubes, particularly those with a preformed bend.
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Affiliation(s)
- Francisco A Perez
- Department of Radiology, Seattle Children's Hospital and University of Washington School of Medicine, Seattle, WA, USA
| | | | - Kelly N Evans
- Department of Pediatrics, Division of Craniofacial Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Marian Giles
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Randolph K Otto
- Department of Radiology, Seattle Children's Hospital and University of Washington School of Medicine, Seattle, WA, USA
| | - Agnes Hunyady
- Department of Anesthesiology and Pain Medicine, Division of Pediatric Anesthesiology, University of Washington School of Medicine, Seattle, WA, USA
| | - Katherine R Gentry
- Department of Anesthesiology and Pain Medicine, Division of Pediatric Anesthesiology, University of Washington School of Medicine, Seattle, WA, USA
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Garcia-Marcinkiewicz AG, Stricker PA. Craniofacial surgery and specific airway problems. Paediatr Anaesth 2020; 30:296-303. [PMID: 31837242 DOI: 10.1111/pan.13790] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 12/10/2019] [Indexed: 11/28/2022]
Abstract
Infants and children undergoing craniofacial surgery may present with a wide range of diseases and conditions posing an array of challenges to the anesthesiologist. Optimal perioperative care requires an understanding of these diseases and their impact on airway and anesthetic management. For those children with anomalies affecting airway anatomy, soft tissues of the head and neck, or skeletal mobility, advanced airway management techniques (ie, modalities other than direct laryngoscopy) may be required to secure the airway. Additionally, some craniofacial surgical procedures have direct implications on airway management, such as with Le Fort III midface advancement involving halo distractor application, where the distractor device precludes facemask ventilation. For all of these patients, the anesthetic and airway management plans must be tailored to the surgery being performed, the patient's specific conditions, and take into consideration all phases of perioperative care. In this review, we present some of the more commonly encountered craniofacial abnormalities affecting airway management.
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Affiliation(s)
- Annery G Garcia-Marcinkiewicz
- The Children's Hospital of Philadelphia, Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Paul A Stricker
- The Children's Hospital of Philadelphia, Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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Xu J, Chen K, Deng X, Wei L, Yang D, Wang Y. Prediction of difficult laryngoscopy in school-aged patients with microtia. Minerva Anestesiol 2020; 86:387-393. [PMID: 31922374 DOI: 10.23736/s0375-9393.19.13895-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Children with microtia may experience difficult laryngoscopy because the ear and the mandible develop from the first and second bronchial arches and clefts. METHODS In this prospective observational study, we enrolled 166 patients (6-14 years old) with microtia scheduled for auricular reconstruction with autologous costal cartilage framework. Airway of the subjects was assessed preoperatively with the Modified Mallampati classification, Thyromental distance, Interincisor gap, Forward protrusion of the mandible and Horizontal length of the mandible. Anesthesiologist performed the direct laryngoscopy. Difficult laryngoscopy was classified as grade III or IV based on the Cormack-Lehane classification. RESULTS A total of 166 patients completed the study, including 158 (95%) isolated microtia patients and 8 (5%) hemifacial microsomia patients. The incidence of difficult laryngoscopy was 34/166 (20.5%) in all patients, 3/8 (37.5%) in hemifacial microsomia patients, 31/158 (19.6%) in isolated microtia patients (P=0.35). Multivariate logistic regression shows that Thyromental distance, Interincisor gap, Forward protrusion of the mandible are all independent predictors of difficult laryngoscopy. The sensitivity and specificity of each predictor were: Thyromental distance (82.35%, 89.39%), Interincisor gap (58.82%, 86.36%), and Forward protrusion (17.65%, 97.73%), respectively. The cutoff values of Thyromental distance and Interincisor gap for prediction of difficult laryngoscopy were 4.0 cm and 3.3 cm. The best combination of predictors was Thyromental distance/Interincisor gap/Forward protrusion of the mandible with a sensitivity of 94.12% and specificity of 86.36%. CONCLUSIONS The combination of Thyromental distance, Interincisor gap, and Forward protrusion of the mandible is the optimal assessment to predict difficult laryngoscopy in school-aged patients with microtia.
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Affiliation(s)
- Jin Xu
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Keyu Chen
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaoming Deng
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China -
| | - Lingxin Wei
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dong Yang
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ye Wang
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Ahuja V, Nyima T, Verma P, Gupta P. Use of the GlideScope ® for enhanced airway challenges in Treacher Collins syndrome. Indian J Anaesth 2020; 64:161-163. [PMID: 32139941 PMCID: PMC7017657 DOI: 10.4103/ija.ija_704_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 11/19/2019] [Accepted: 11/29/2019] [Indexed: 11/04/2022] Open
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Lin Y, Ma X, Teng L. [Progress of diagnosis and treatment of upper respiratory obstruction in patients with Treacher Collins syndrome]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:1578-1583. [PMID: 31823562 DOI: 10.7507/1002-1892.201903041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To summarize the progress of diagnosis and treatment of upper respiratory obstruction in patients with Treacher Collins syndrome (TCS). Methods The domestic and abroad literature about the diagnosis and treatment of upper respiratory obstruction in patients with TCS was extensively reviewed and analyzed. Results TCS is an autosomal-dominant craniofacial developmental syndrome. It is often accompanied by midface and/or mandibular hypoplasia, soft tissue hypertrophy, and other respiratory tissue developmental abnormalities, which can lead to different degrees of upper respiratory obstruction symptoms. Respiratory obstruction in patients with TCS is affected by many factors, and the obstructive degree are different. Early detection of the causes and obstructive sites and adopted targeted treatments can relieve the symptoms of respiratory obstruction and avoid severe complications. Conclusion Due to the low incidence of TCS, there is still a lack of high-quality research evidence to guide clinical treatment. Large-scale and prospective clinical studies are needed to provide new ideas for the treatment and prevention of upper respiratory obstruction.
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Affiliation(s)
- Yanxian Lin
- Department of Craniomaxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100144, P.R.China
| | - Xiaoyang Ma
- Department of Craniomaxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100144, P.R.China
| | - Li Teng
- Department of Craniomaxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100144,
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20
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Current Concepts in the Management of the Difficult Pediatric Airway. CURRENT ANESTHESIOLOGY REPORTS 2019. [DOI: 10.1007/s40140-019-00319-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Kanemaru H, Tsurumaki T, Kurata S, Tanaka Y, Yoshikawa H, Sato Y, Kodama Y, Suda A, Yamada Y, Seo K. Endotracheal Intubation Complicated by a Palatal Tooth in a Patient With Treacher Collins Syndrome. Anesth Prog 2019; 66:42-43. [PMID: 30883232 DOI: 10.2344/anpr-66-02-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
We report a case of difficult endotracheal intubation in a patient with Treacher Collins syndrome. A sixteen-year-old female patient scheduled for general anesthesia had a displaced palatal tooth that interfered with laryngoscope insertion into the pharyngeal space. To address this problem, we successfully performed endotracheal intubation using a fiberscope while elevating the epiglottic vallecula using a King Vision™ video laryngoscope. A later operation was performed after tooth extraction without difficult laryngoscopy. Our experience stresses the importance of removing obstructions to laryngoscopic inspection prior to general anesthesia.
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Affiliation(s)
- Hiroko Kanemaru
- Department of Dental Anesthesiology, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Tatsuru Tsurumaki
- Division of Dental Anesthesiology, Graduate School of Medicine and Dental Sciences, Niigata University, Niigata, Japan
| | - Shigenobu Kurata
- Division of Dental Anesthesiology, Graduate School of Medicine and Dental Sciences, Niigata University, Niigata, Japan
| | - Yutaka Tanaka
- Department of Dental Anesthesiology, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Hiroyuki Yoshikawa
- Department of Dental Anesthesiology, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Yumiko Sato
- Department of Dental Anesthesiology, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Yuki Kodama
- Department of Dental Anesthesiology, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Akiko Suda
- Department of Dental Anesthesiology, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Yurie Yamada
- Center for Advanced Oral Science, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Kenji Seo
- Division of Dental Anesthesiology, Graduate School of Medicine and Dental Sciences, Niigata University, Niigata, Japan
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Niwa Y, Takeuchi M. Dams TuLip-i™ is a useful device for performing fiberscopy-guided orotracheal intubation in a patient with Treacher Collins syndrome. J Clin Anesth 2019; 56:32-34. [PMID: 30684921 DOI: 10.1016/j.jclinane.2019.01.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 01/11/2019] [Accepted: 01/18/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Yasunori Niwa
- Department of Anesthesiology and Critical Care Medicine, Jichi Medical University, 3311-1, Yakushiji, Shimotsuke-Shi, Tochigi-Ken 329-0498, Japan.
| | - Mamoru Takeuchi
- Department of Anesthesiology and Critical Care Medicine, Jichi Medical University, 3311-1, Yakushiji, Shimotsuke-Shi, Tochigi-Ken 329-0498, Japan
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Pérez Fernández-Escandón Á, Hevia Sánchez V, Llorente Pendás S, Molina Montalva F. Difficult airway management in a patient with Treacher Collins syndrome using two-part surgery. ACTA ACUST UNITED AC 2019; 66:230-234. [PMID: 30661728 DOI: 10.1016/j.redar.2018.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 10/16/2018] [Accepted: 12/05/2018] [Indexed: 11/16/2022]
Abstract
Treacher Collins syndrome (TCS), Franceschetti-Zwahlen-Klein, or mandibulofacial dysostosis, is a rare disorder of craniofacial development (incidence of approximately 1:50.000 live births). TCS is relevant to the anaesthetist because it can cause difficulties in airway management. A case report is presented of a 24 year-old woman who was referred to our institution for facial reconstruction surgery in two stages. In both surgeries Airtraq™ was essential for airway management. By presenting this case, it is intended to show that planning, communication and teamwork are indispensable for patient safety.
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Affiliation(s)
- Á Pérez Fernández-Escandón
- Departamento de Anestesiología y Reanimación, Centro médico de Asturias, Universidad de Oviedo, Oviedo, Asturias, España.
| | - V Hevia Sánchez
- Departamento de Anestesiología y Reanimación, Centro médico de Asturias, Universidad de Oviedo, Oviedo, Asturias, España
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Fuentes R, De la Cuadra JC, Lacassie H, González A. Difficult fiberoptic tracheal intubation in 1 month-old infant with Treacher Collins Syndrome. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ENGLISH EDITION) 2018. [PMID: 27692368 PMCID: PMC9391677 DOI: 10.1016/j.bjane.2015.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Case report Conclusion
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Affiliation(s)
- Ricardo Fuentes
- Pontificia Universidad Católica de Chile, Facultad de Medicina, División de Anestesiología, Santiago, Chile
| | - Juan Carlos De la Cuadra
- Pontificia Universidad Católica de Chile, Facultad de Medicina, División de Anestesiología, Santiago, Chile
| | - Hector Lacassie
- Pontificia Universidad Católica de Chile, Facultad de Medicina, División de Anestesiología, Santiago, Chile
| | - Alejandro González
- Pontificia Universidad Católica de Chile, Facultad de Medicina, División de Anestesiología, Santiago, Chile.
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Abstract
This article reviews the presentation of children with craniofacial anomalies by the most common sites of airway obstruction. Major craniofacial anomalies may be categorized into those with midface hypoplasia, mandible hypoplasia, combined midface and mandible hypoplasia, and midline deformities. Algorithms of airway interventions are provided to guide the initial management of these complex patients.
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Marques-Pires R, Trindade H. The airway approach to a neonate with Treacher Collins syndrome - Case report. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2017; 64:233-236. [PMID: 28094032 DOI: 10.1016/j.redar.2016.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 10/08/2016] [Accepted: 10/10/2016] [Indexed: 11/16/2022]
Abstract
Neonates and small infants with syndromes characterized by the presence of craniofacial abnormalities may represent great challenges regarding the management of the airway. We describe the case of a 9-day-old neonate with Treacher Collins syndrome, in which a laryngeal mask was essential to improve the airway obstruction, ventilate the patient and serve as an airway conduit for a fiberoptic intubation. By presenting this case, we intend to show that in neonates with Treacher Collins syndrome, in whom difficulties ventilation and intubation are expected, a thoughtful airway management planning is mandatory.
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Affiliation(s)
- R Marques-Pires
- Anesthesiology Department, Centro Hospitalar de Lisboa Central, EPE, Lisboa, Portugal.
| | - H Trindade
- Anesthesiology Department, Centro Hospitalar de Lisboa Central, EPE, Lisboa, Portugal
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Fitz-James Antoine I, Carullo V, Hernandez CK, Tepper O. Anatomic Approach to Airway Management of the Syndromic Child. Int Anesthesiol Clin 2016; 55:52-64. [PMID: 27941366 DOI: 10.1097/aia.0000000000000131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Ingrid Fitz-James Antoine
- *Department of Anesthesiology, Montefiore Medical Center, The University Hospital of Albert Einstein College of Medicine, Bronx, New York †Department of Plastic Surgery, Montefiore Medical Center, The University Hospital of Albert Einstein College of Medicine, Bronx, New York
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Morimoto Y, Ohyamaguchi A, Inoue M, Yokoe C, Hanamoto H, Imaizumi U, Sugimura M, Niwa H. Airway management for glossopexy in infants with micrognathia and obstructive breathing. J Clin Anesth 2016; 36:127-132. [PMID: 28183550 DOI: 10.1016/j.jclinane.2016.10.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 08/11/2016] [Accepted: 10/27/2016] [Indexed: 11/30/2022]
Abstract
STUDY OBJECTIVES To identify airway management and tracheal intubation techniques for glossopexy in infants with preexisting airway obstruction under general anesthesia. DESIGN Retrospective, observational study. SETTINGS Operating room of a university hospital between January 2003 and March 2015. All operations were performed by oral and maxillofacial surgeons. PATIENTS Thirteen patients who received general anesthesia for glossopexy and reversal after 7 months. MEASUREMENTS The medical records of these infants were retrospectively examined to evaluate the following: age, sex, height and weight at surgery, preoperative airway status, tracheal intubation route (oral or nasal), method for inducing general anesthesia, method for establishing the airway during mask ventilation, apparatus used for tracheal intubation, Cormack-Lehane classification when using a Macintosh laryngoscope and video laryngoscope, and the need for airway placement after extubation. RESULTS Prone positioning and/or an airway of some kind before surgery were required in 38.5% of infants needing glossopexy. Difficult mask ventilation was common, occurring in 50% of the patients, and the incidence of airway placement during mask ventilation was significantly higher in infants with preoperative complete or incomplete obstruction (100%) than in infants with snoring (25%). Of these high-risk infants, 25% could not be intubated with a direct laryngoscope or Glidescope Cobalt and required fiberoptic intubation. CONCLUSION There are severe cases of infants with difficult mask ventilation and difficult tracheal intubation in which a fiberscope is required because video laryngoscopy fails to improve the view of the larynx.
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Affiliation(s)
- Yoshinari Morimoto
- Division of Anesthesiology, Department of Critical Care Medicine and Dentistry, Graduate School of Dentistry, Kanagawa Dental University, 82, Inaoka-cho, Yokosuka, Kanagawa 238-8580, Japan; Department of Dental Anesthesiology, Graduate School of Dentistry, Osaka University, 1-8, Yamadaoka, Suita, Osaka 565-0871, Japan.
| | - Aiko Ohyamaguchi
- Department of Dental Anesthesiology, Graduate School of Dentistry, Osaka University, 1-8, Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Mika Inoue
- Department of Dental Anesthesiology, Graduate School of Dentistry, Osaka University, 1-8, Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Chizuko Yokoe
- Division of Anesthesiology, Department of Critical Care Medicine and Dentistry, Graduate School of Dentistry, Kanagawa Dental University, 82, Inaoka-cho, Yokosuka, Kanagawa 238-8580, Japan
| | - Hiroshi Hanamoto
- Department of Dental Anesthesiology, Graduate School of Dentistry, Osaka University, 1-8, Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Uno Imaizumi
- Division of Anesthesiology, Department of Critical Care Medicine and Dentistry, Graduate School of Dentistry, Kanagawa Dental University, 82, Inaoka-cho, Yokosuka, Kanagawa 238-8580, Japan
| | - Mitsutaka Sugimura
- Department of Dental Anesthesiology, Graduate School of Dentistry, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima 890-8544, Japan
| | - Hitoshi Niwa
- Department of Dental Anesthesiology, Graduate School of Dentistry, Osaka University, 1-8, Yamadaoka, Suita, Osaka 565-0871, Japan
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Fuentes R, De la Cuadra JC, Lacassie H, González A. [Difficult fiberoptic tracheal intubation in 1 month-old infant with Treacher Collins Syndrome]. Rev Bras Anestesiol 2016; 68:87-90. [PMID: 27692368 DOI: 10.1016/j.bjan.2015.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 02/11/2015] [Indexed: 11/16/2022] Open
Abstract
Neonates and small infants with craniofacial malformation may be very difficult or impossible to mask ventilate or intubate. We would like to report the fiberoptic intubation of a small infant with Treacher Collins Syndrome using the technique described by Ellis et al. CASE REPORT An one month-old infant with Treacher Collins Syndrome was scheduled for mandibular surgery under general endotracheal anesthesia. Direct laryngoscopy for oral intubation failed to reveal the glottis. Fiberoptic intubation using nasal approach and using oral approach through a 1.5 size laryngeal mask airway were performed; however, both approach failed because the fiberscope loaded with a one 3.5mm ID uncuffed tube was stuck inside the nasal cavity or inside the laryngeal mask airway respectively. Therefore, the laryngeal mask airway was keep in place and the fiberoptic intubation technique described by Ellis et al. was planned: the tracheal tube with the 15mm adapter removed was loaded proximally over the fiberscope; the fiberscope was advanced under video-screen visualization into the trachea; the laryngeal mask airway was removed, leaving the fiberscope in place; the tracheal tube was passed completely through the laryngeal mask airway and advanced down over the fiberscope into the trachea; the fiberscope was removed and the 15mm adapter was reattached to the tracheal tube. CONCLUSION The fiberoptic intubation method through a laryngeal mask airway described by Ellis et al. can be successfully used in small infants with Treacher Collins Syndrome.
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Affiliation(s)
- Ricardo Fuentes
- Pontificia Universidad Católica de Chile, Facultad de Medicina, División de Anestesiología, Santiago, Chile
| | - Juan Carlos De la Cuadra
- Pontificia Universidad Católica de Chile, Facultad de Medicina, División de Anestesiología, Santiago, Chile
| | - Hector Lacassie
- Pontificia Universidad Católica de Chile, Facultad de Medicina, División de Anestesiología, Santiago, Chile
| | - Alejandro González
- Pontificia Universidad Católica de Chile, Facultad de Medicina, División de Anestesiología, Santiago, Chile.
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Abstract
Almost all supraglottic airways (SGAs) are now available in pediatric sizes. The availability of these smaller sizes, especially in the last five years has brought a marked change in the whole approach to airway management in children. SGAs are now used for laparoscopic surgeries, head and neck surgeries, remote anesthesia; and for ventilation during resuscitation. A large number of reports have described the use of SGAs in difficult airway situations, either as a primary or a rescue airway. Despite this expanded usage, there remains little evidence to support its usage in prolonged surgeries and in the intensive care unit. This article presents an overview of the current options available, suitability of one over the other and reviews the published data relating to each device. In this review, the author also addresses some of the general concerns regarding the use of SGAs and explores newer roles of their use in children.
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Affiliation(s)
- Rakhee Goyal
- Department of Anesthesia and Critical Care, Armed Forces Medical College, Pune, Maharashtra, India
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Sethi D. Airway management in a child with Treacher Collins syndrome using C-MAC videolaryngoscope. Anaesth Crit Care Pain Med 2015; 35:67-68. [PMID: 26589298 DOI: 10.1016/j.accpm.2015.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Accepted: 06/03/2015] [Indexed: 11/17/2022]
Affiliation(s)
- Divya Sethi
- Department of Anesthesia, Employees' State Insurance Postgraduate Institute of Medical Sciences and Research (ESI PGIMSR), New Delhi 110015, India.
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Utility of a gum-elastic bougie for difficult airway management in infants: a simulation-based crossover analysis. BIOMED RESEARCH INTERNATIONAL 2015; 2015:617805. [PMID: 26495306 PMCID: PMC4606451 DOI: 10.1155/2015/617805] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 05/26/2015] [Indexed: 02/07/2023]
Abstract
Background. Direct laryngoscopy with the Miller laryngoscope (Mil) for infant tracheal intubation is often difficult to use even for skilled professionals. We performed a simulation trial evaluating the utility of a tracheal tube introducer (gum-elastic bougie (GEB)) in a simulated, difficult infant airway model. Methods. Fifteen anesthesiologists performed tracheal intubation on an infant manikin at three different degrees of difficulty (normal [Cormack-Lehane grades (Cormack) 1-2], cervical stabilization [Cormack 2-3], and anteflexion [Cormack 3-4]) with or without a GEB, intubation success rate, and intubation time. Results. In the normal and cervical stabilization trials, all intubation attempts were successful regardless of whether or not the GEB was used. In contrast, only one participant succeeded in tracheal intubation without the GEB in the anteflexion trial; the success rate significantly improved with the GEB (P = 0.005). Intubation time did not significantly change under the normal trial with or without the GEB (without, 12.7 ± 3.8 seconds; with, 13.4 ± 3.6 seconds) but was significantly shorter in the cervical stabilization and anteflexion trials with the GEB. Conclusion. GEB use shortened the intubation time and improved the success rate of difficult infant tracheal intubation by anesthesiologists in simulations.
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Rao L, Jumana H, Gururajrao M, Venkatesh KH. Successful management of difficult airway in children with the use of adult fibreoptic bronchoscope. Indian J Anaesth 2015; 59:50-1. [PMID: 25684815 PMCID: PMC4322104 DOI: 10.4103/0019-5049.149453] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- Latha Rao
- Department of Anaesthesiology and Critical Care, Apollo Hospitals, Bengaluru, Karnataka, India
| | - Haji Jumana
- Department of Anaesthesiology and Critical Care, Apollo Hospitals, Bengaluru, Karnataka, India
| | - Madhusudhan Gururajrao
- Department of Plastic and Cosmetic Surgery, BGS Global Hospitals, Bengaluru, Karnataka, India
| | - Keshavan H Venkatesh
- Division of Neuroanaesthesiology and Critical Care, Apollo Hospitals, Bengaluru, Karnataka, India
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36
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Cobb AR, Green B, Gill D, Ayliffe P, Lloyd TW, Bulstrode N, Dunaway DJ. The surgical management of Treacher Collins syndrome. Br J Oral Maxillofac Surg 2014; 52:581-9. [DOI: 10.1016/j.bjoms.2014.02.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2013] [Accepted: 02/11/2014] [Indexed: 02/07/2023]
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Guerrero-Domínguez R, Acebedo-Martínez E, López-Herrera-Rodríguez D, Jiménez I. [Unintended intraoperative extubation in a patient with Treacher Collins syndrome: usefullness of GlideScope(®) videolaryngoscope]. ACTA ACUST UNITED AC 2014; 61:467-9. [PMID: 24439524 DOI: 10.1016/j.redar.2013.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 11/12/2013] [Accepted: 11/12/2013] [Indexed: 11/28/2022]
Affiliation(s)
- R Guerrero-Domínguez
- Servicio de Anestesiología y Reanimación, Hospitales Universitarios Virgen del Rocío, Sevilla, España.
| | - E Acebedo-Martínez
- Servicio de Anestesiología y Reanimación, Hospitales Universitarios Virgen del Rocío, Sevilla, España
| | - D López-Herrera-Rodríguez
- Servicio de Anestesiología y Reanimación, Hospitales Universitarios Virgen del Rocío, Sevilla, España
| | - I Jiménez
- Servicio de Anestesiología y Reanimación, Hospitales Universitarios Virgen del Rocío, Sevilla, España
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Soh J, Shin HW, Choi SU, Lim CH, Lee HW. Easy airway management using the i-gel™ supraglottic airway in a patient with Treacher Collins syndrome. Korean J Anesthesiol 2014; 67:S17-8. [PMID: 25598889 PMCID: PMC4295963 DOI: 10.4097/kjae.2014.67.s.s17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Jungsub Soh
- Department of Anesthesiology and Pain Medicine, Korea University College of Medicine, Seoul, Korea
| | - Hye Won Shin
- Department of Anesthesiology and Pain Medicine, Korea University College of Medicine, Seoul, Korea
| | - Sung Uk Choi
- Department of Anesthesiology and Pain Medicine, Korea University College of Medicine, Seoul, Korea
| | - Choon Hak Lim
- Department of Anesthesiology and Pain Medicine, Korea University College of Medicine, Seoul, Korea
| | - Hye Won Lee
- Department of Anesthesiology and Pain Medicine, Korea University College of Medicine, Seoul, Korea
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Failure of the Laryngeal Mask Airway Unique™ and Classic™ in the Pediatric Surgical Patient. Anesthesiology 2013; 119:1284-95. [DOI: 10.1097/aln.0000000000000015] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Abstract
Background:
Although predictors of laryngeal mask airway failure in adults have been elucidated, there remains a paucity of data regarding laryngeal mask airway failure in children.
Methods:
The authors performed a retrospective database review of all pediatric patients who received a laryngeal mask anesthetic at their institution from 2006 to 2010. Device brands were restricted to LMA Unique™ (Cardinal Health, Dublin, OH) and LMA Classic™ (LMA North America, San Diego, CA), and primary outcome was laryngeal mask failure, defined as any airway event requiring device removal and tracheal intubation. Potential risk factors were analyzed with both univariate and multivariate techniques and included medical history, physical examination, surgical, and anesthetic characteristics.
Results:
Of the 11,910 anesthesia cases performed in the study, 102 cases (0.86%) experienced laryngeal mask failure. Common presenting features of laryngeal mask failures included leak (25%), obstruction (48%), and patient intolerance such as intractable coughing/bucking (11%). Failures occurred before incision in 57% of cases and after incision in 43%. Independent clinical associations included ear/nose/throat surgical procedure, nonoutpatient admission status, prolonged surgical duration, congenital/acquired airway abnormality, and patient transport.
Conclusions:
The findings of the study support the use of the LMA Unique™ and LMA Classic™ as reliable pediatric supraglottic airway devices, demonstrating relatively low failure rates. Predictors of laryngeal mask airway failure in the pediatric surgical population do not overlap with those in the adult population and should therefore be independently considered.
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Espinosa Fernández MG, Sánchez Martínez JE, Roldán Mateo AM, Martínez MA. [Neonatal osteogenic mandibular distraction in patient diagnosed with Treacher Collins syndrome]. An Pediatr (Barc) 2013; 80:e52-3. [PMID: 24071556 DOI: 10.1016/j.anpedi.2013.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Revised: 04/30/2013] [Accepted: 05/19/2013] [Indexed: 11/15/2022] Open
Affiliation(s)
| | | | - A M Roldán Mateo
- Unidad de Neonatología, Hospital Materno Infantil Carlos Haya, Málaga, España
| | - M A Martínez
- Unidad de Cirugía Máxilo Facial, Hospital Carlos Haya, Málaga, España
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Frawley G, Espenell A, Howe P, Shand J, Heggie A. Anesthetic implications of infants with mandibular hypoplasia treated with mandibular distraction osteogenesis. Paediatr Anaesth 2013; 23:342-8. [PMID: 23043528 DOI: 10.1111/pan.12049] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/04/2012] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To document the incidence of difficult intubation following mandibular distraction osteogenesis (MDO) in children with severe mandibular hypoplasia. BACKGROUND Syndromes associated with significant mandibular hypoplasia, especially Pierre Robin sequence, provide a challenge in airway management both in and out of the operating room. Mandibular advancement using mandibular distraction osteogenesis devices has been used in infants in an attempt to reduce the incidence of acute life-threatening airway obstruction. Whether MDO also reduces the incidence of difficult intubation has not been adequately described. METHODS A retrospective chart review of 51 infants with upper airway obstruction secondary to mandibular hypoplasia who required MDO between January 2002 and 2012. The primary outcome was the incidence of difficult or failed intubation. Secondary outcomes were the relationship between syndrome type and the incidence of difficult intubation. RESULTS Fifty-one PRS infants were identified. Twenty-eight patients had isolated PRS, six had syndromic PRS, seven had Treacher Collins syndrome, and 10 had another coexisting syndrome. Prior to mandibular distraction osteogenesis (MDO), the incidence of difficult intubation was 71%, with the highest incidence in patients with Treacher Collins syndrome (100%), sPRS syndrome (100%), and PRS (65%). Following MDO, the incidence of difficult intubation was 8.3%. The difference was statistically significant for all patients (Kruskal-Wallis rank test P = 0.0001) those with isolated PRS (P = 0.0001), syndromic PRS (P = 0.0023), and other syndromes (P = 0.0002), but not for Treacher Collins syndrome (P = 0.21). Three patients had pre existing tracheostomies. CONCLUSIONS In a select group of infants with severe upper airway obstruction who have failed nonsurgical airway interventions, mandibular distraction osteogenesis reduces the incidence of difficult mask ventilation and difficult intubation. We were not able to compare the improvement in airway management to a comparable group of PRS infants who did not undergo surgical intervention. The improvement in laryngeal view was most marked for infants with isolated PRS but no significant benefit was demonstrated in infants with TCS.
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Affiliation(s)
- Geoff Frawley
- Department of Paediatric Anaesthesia and Pain Management, Royal Children's Hospital, Melbourne, Vic., Australia.
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Current World Literature. Curr Opin Anaesthesiol 2013; 26:98-104. [DOI: 10.1097/aco.0b013e32835cb4f0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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