Paediatric anaesthesia
-
Education in medicine, informed by research findings, is moving away from the traditional apprenticeship model and increasingly embraces new, active learning methodologies. In this article, we will review these methodologies along with adult learning theories; we explore the available evidence on acquisition and maintenance of pediatric airway management skills, including technical and nontechnical skills. We recall the elements of a competency-based curriculum and how they can be applied in pediatric airway skill training and suggest mapping strategies based on research evidence. We propose future directions in education and educational research in the field.
-
Paediatric anaesthesia · Mar 2020
ReviewAirway ultrasound: point of care in children - the time is now.
Point-of-care ultrasonography of the airway is becoming a first-line noninvasive adjunct assessment tool of the pediatric airway. It is defined as a focused and goal-directed portable ultrasonography brought to the patient and performed and interpreted on the spot by the provider. Successful use requires a thorough understanding of airway anatomy and ultrasound experience. ⋯ Although it is not standard of care yet, there is significant potential for the integration of ultrasound technology into the routine care of the airway.
-
Laryngeal and respiratory reflexes are vitally important defense mechanisms against foreign body aspiration, safeguarding airway patency, and ventilation. These highly preserved automatisms easily overrule external influences like willpower or (anesthetic) medication. Prevention and anticipation are, therefore, the essential strategies to avoid adverse events and damage, and treatment is most effective in the early stage of the reflex response. The physiology and pathophysiology of the various defensive reflexes as well as a comprehensive anesthetic approach to prevention and treatment are outlined in this review.
-
Paediatric anaesthesia · Mar 2020
ReviewTracheal extubation in children: planning, technique and complications.
Although poorly described in textbooks and rarely a topic of lecture, tracheal extubation is a critical phase of anesthetic care. It should therefore be carefully planned taking into account simple physiology-based principles to maintain the upper airway patent and avoid lung de-recruitment, but also the pharmacology of all anesthetic agents used. Although the management of most of its complications can be learned in a clinical simulation environment, the basic techniques can so far only be taught at the bedside, in the operating room. In this paper, the process of extubation is described in successive steps: preparation, return to adequate spontaneous ventilation, awake versus deep extubation, timing according to the child's breathing cycle, extubation in the operating room or in the Postanesthesia Care unit, child's management immediately after extubation, diagnosis and treatment of the early complications, and finally, how to prepare for a difficult reintubation.
-
Paediatric anaesthesia · Mar 2020
ReviewEducational Review on the Design of the Perfect Pediatric Supraglottic Airway Device.
The design evolution of the pediatric supraglottic airway device has experienced a long and productive journey. We have a wealth of clinical studies to support progress and advancements in pediatric clinical practice. ⋯ Current pediatric supraglottic airway devices may be improved in design to be more ideal. Industry-changing technological advancements are likely to occur in the near future, which may further improve clinical performance of these devices.