Paediatric anaesthesia
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Four basic types of visual aids are used for teaching airway management and decision-making in simulated as well as in real clinical situations: universal algorithms, sets of limited algorithms, concept-based cognitive aids, and checklists. The first three may represent an evolution in the understanding of the role of human error in both successful and failed airway management. Complex visual aids such as the American Society of Anesthesiology difficult airway algorithm may be more useful for teaching, while graphic cognitive aids like the Vortex may be more helpful for decision-making under stress. Not surprisingly, there is a lack of outcome studies, although some cognitive aids have been evaluated in simulation settings.
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Paediatric anaesthesia · Mar 2020
ReviewArtificial intelligence, machine learning and the pediatric airway.
Artificial intelligence and machine learning are rapidly expanding fields with increasing relevance in anesthesia and, in particular, airway management. The ability of artificial intelligence and machine learning algorithms to recognize patterns from large volumes of complex data makes them attractive for use in pediatric anesthesia airway management. ⋯ We critically assess the current evidence on the use of artificial intelligence and machine learning in the assessment, diagnosis, monitoring, procedure assistance, and predicting outcomes during pediatric airway management. Further, we discuss the limitations of these technologies and offer areas for focused research that may bring pediatric airway management anesthesiology into the era of artificial intelligence and machine learning.
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Paediatric anaesthesia · Mar 2020
ReviewAirway Management for Neonates Requiring Ex Utero Intrapartum Treatment (EXIT).
In utero congenital malformations in the fetus can occasionally lead to an obstructed airway at birth accompanied by hypoxic injury or peripartum demise, without intervention. Ex utero intrapartum treatment (EXIT) may help reduce morbidity and mortality associated with challenging airways by providing extra time on uteroplacental circulation to secure the airway. Meticulous preparation and planning are crucial for this procedure. ⋯ Based on our experience and literature review, an airway process flow diagram has been created to help assist teams in decision-making for airway intervention in a neonate during the EXIT procedure. The management of the airway in this scenario involves additional unique considerations that accompany handling a partially delivered newborn in the uterine environment. Extensive preparation and team rehearsal are essential to the success of this procedure.
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Paediatric anaesthesia · Mar 2020
ReviewAdaptations in Pediatric Anesthesia Care and Airway Management in the Resource-Poor Setting.
The need for safe and quality pediatric anesthesia care in low- and middle-income countries (LMICs) is huge. An estimated 1.7 billion children do not have access to surgical care, and the majority are in LMICs. In addition, most LMICs do not have the requisite surgical workforce including anesthesia providers. ⋯ There is often a lack of pediatric-sized anesthesia equipment and resources, making management of the local pathology even more challenging. Efforts are being made to offer these providers additional training in pediatric anesthesia skills that incorporate low-fidelity simulation. Out of necessity, anesthesia providers in this setting learn to be resourceful in order to manage complex pathologies with fewer, less ideal resources while still providing a safe anesthetic.
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Paediatric anaesthesia · Mar 2020
ReviewPediatric syndromes with non-craniofacial anomalies impacting the airways.
Syndromes with noncraniofacial abnormalities can be a real challenge in terms of airway management. The key to success is effective preparation, presence of personnel with expertise in difficult pediatric airway management, regular training and familiarity with difficult intubation equipment, and teamwork. Considering that there are a very large number of syndromes, with variable phenotypic expression, the management strategy of every case will be dictated by the anatomical and functional airway as assessed on physical examination and subsidiary examinations before induction of anesthesia.