What's inside the box? Or shall we think outside the box?

Complications associated with paediatric airway management during the COVID-19 pandemic: an international, multicentre, observational study

Respiratory adverse events in adults with COVID-19 undergoing general anaesthesia can be life-threatening. However, there remains a knowledge gap about respiratory adverse events in children with COVID-19. We created an international observational registry to collect airway management outcomes in children with COVID-19 who were having a general anaesthetic. We hypothesised that children with confirmed or suspected COVID-19 would experience more hypoxaemia and complications than those without. Between 3 April 2020 and 1 November 2020, 78 international centres participated. In phase 1, centres collected outcomes on all children (age ≤ 18 y) having a general anaesthetic for 2 consecutive weeks. In phase 2, centres recorded outcomes for children with test-confirmed or suspected COVID-19 (based on symptoms) having a general anaesthetic. We did not study children whose tracheas were already intubated. The primary outcome was the incidence of hypoxaemia during airway management. Secondary outcomes included: incidence of other complications; and first-pass success rate for tracheal intubation. In total, 7896 children were analysed (7567 COVID-19 negative and 329 confirmed or presumed COVID-19 positive). The incidence of hypoxaemia during airway management was greater in children who were COVID-19 positive (24 out of 329 (7%) vs. 214 out of 7567 (3%); OR 2.70 (95%CI 1.70-4.10)). Children who had symptoms of COVID-19 had a higher incidence of hypoxaemia compared with those who were asymptomatic (9 out of 51 (19%) vs. 14 out of 258 (5%), respectively; OR 3.7 (95%CI 1.5-9.1)). Children with confirmed or presumed COVID-19 have an increased risk of hypoxaemia during airway management in conjunction with general anaesthesia.

Pediatric Airway Management in Times of COVID-19-a Review of the Evidence and Controversies

Purpose of Review

This review summarizes and provides a comprehensive narrative synthesis of the current evidence on pediatric airway management during the COVID-19 pandemic.

Recent Findings

The safe care of children undergoing airway management is a primary concern for pediatric anesthesiologists. The COVID-19 pandemic has brought challenges related to airway management and the use of personal protective equipment, aerosol barriers, and the need for simulation and intubation teams. The risk of COVID-19 transmission to the health care worker may be lower in children due to the smaller volume of aerosol dispersal. The implementation of vaccinations may further reduce the risk to health care workers. Evidence demonstrating the impact of COVID-19 on airway outcomes in children is necessary to inform their care.

Summary

This review shows that pediatric airway management can be a safe procedure for both the patient and provider in the right setting. The use of appropriate personal protective equipment, particularly focusing on protection from aerosolized particles, is paramount to reduce infection risk. However, there are opportunities for future research.

[SARS-CoV-2 positive child-What to do if inhalation induction of anesthesia is unavoidable?]

Die inhalative Anästhesieeinleitung hat bei Kindern aufgrund schwieriger Venenverhältnisse und insbesondere bei unkooperativen Patienten einen hohen Stellenwert. In der europaweiten Studie zu Komplikationen in der Kinderanästhesie (APRICOT-Studie) mit fast 30.000 eingeschlossenen Patienten wurde bei 48 % der Kinder die Narkose inhalativ eingeleitet.

Unter den Bedingungen der Coronapandemie stellt die inhalative Anästhesieeinleitung aufgrund der potenziellen Aerosolfreisetzung allerdings ein erhöhtes Infektionsrisiko dar. Für die Anästhesieeinleitung und die definitive Atemwegssicherung wird bei Erwachsenen und Kindern in der aktuellen Pandemiesituation eine „rapid sequence induction“ empfohlen.

Der vorliegende Fall demonstriert, dass es bei Kindern durchaus Situationen geben kann, in denen die inhalative Narkoseeinleitung unvermeidbar ist, und zeigt eine potenzielle Verfahrensweise zur Reduktion des Infektionsrisikos für das betreuende Anästhesiepersonal.