ABSTRACT
Direct laryngoscopy (DL) is the most commonly used technique for tracheal intubation, but there is ongoing interest in new devices that have high success rates and are easily learned. The pediatric Airtraq (AT) is a recently developed intubation device that allows visualization of the glottis and intubation of the trachea without alignment of the oral, pharyngeal and tracheal axes. We studied the efficacy of the AT compared to the DL for laryngoscopy of young children with normal airway anatomy. In this prospective study, 49 children (5 yr and younger) scheduled for elective surgery under general anesthesia were randomized into two groups: intubation using direct laryngoscopy (DL group) and laryngoscopy using the Airtraq (AT group). Time to best view, time to intubate, first attempt success rate (FASR), and percentage of glottic opening seen (percentage of glottis opening score) were recorded. Data are presented as median and interquartile range. Time to best view was five (4, 7) sec in DL and five (4, 7.5) sec in AT. Time to intubate was 18 (14.7, 21) sec in DL and 22.5 (19.5, 25.5) sec in AT (P = 0.002). FASR was 100% in the DL and 83% in the AT. The percentage of glottis opening score was 80% (range 60-100%) in the DL and 100% (range 100-100%) in the AT (P < 0.001). In young children with normal airway anatomy, the AT provides a better view of the glottis than the standard laryngoscope, but it takes longer to intubate the trachea and the FASR is lower.
Subject(s)
Anesthesiology/education , Education, Nursing , Hypnotics and Sedatives/administration & dosage , Magnetic Resonance Imaging , Anesthesia, General/adverse effects , Anesthesia, General/classification , Child , Consciousness/drug effects , Humans , Hypnotics and Sedatives/adverse effects , Infant , Respiration/drug effects , SafetyABSTRACT
Seizures occurred in two adolescents approximately six hours after sedation with propofol for bone marrow biopsy. Case #1 was a patient with chronic renal failure, hypertension, and anaemia. Case #2 had just been diagnosed with acute lymphocytic leukaemia. Neither child had experienced seizures before, and both recovered without neurological sequelae. Although other factors may have caused the seizures, the episodes have raised concerns about the safety of propofol for patients travelling home after out-patient surgery. Further study is required to explain the cause of this complication or, at least, to identify risk factors.
