Perioperative pulmonary aspiration is infrequent and low risk in pediatric anesthetic practice.

Recent studies have reported perioperative pulmonary aspiration in pediatric practice to be an uncommon problem associated with low morbidity and mortality. This paper examines the recent publications in both the adult and pediatric literature and looks at some of the potential risk factors involved, both patient and anesthetic, in the development of aspiration of gastric contents. We also look at the risk of severe morbidity following pulmonary aspiration and speculate on possible reasons behind the assertion that pulmonary aspiration in pediatric anesthetic practice is rare and a low-risk event.

Pulmonary aspiration in pediatric anesthetic practice in the UK: a prospective survey of specialist pediatric centers over a one-year period.

BACKGROUND: Pulmonary aspiration of gastric contents is a potentially devastating complication of anesthesia. AIMS: This prospective multicenter survey of specialist pediatric centers in the UK set out to elucidate the incidence, risk factors, and the outcome of such events. The survey took place over a twelve-month period via a web-based secure reporting system. RESULTS: Over the twelve-month period, 24 cases of pulmonary aspiration were reported. Over that time period, there were 118 371 cases performed at the eleven pediatric centers. The overall incidence of pulmonary aspiration is therefore 1 in 4932 cases or 2 in 10 000 cases. Over that time period, there were 18 cases during elective surgery and six cases in nonelective/emergency surgery. The incidence of pulmonary aspiration in the elective situation is therefore 1 in 5076 cases or 2.0 per 10 000 cases. The incidence in emergency procedures is 1 in 4498 cases or 2.2 per 10 000 cases. The timing and severity of deterioration were recorded. In the study period, 8 of 24 cases did not deteriorate, 13 of 24 deteriorated with immediate effect, and the further 3 of 24 deteriorated within the next hour. The deterioration was mild in 11 patients requiring medical management only, and the deterioration was severe in five patients. Those five patients required ventilation for varying durations of time. All patients made a full recovery. CONCLUSIONS: This multicenter survey of specialist pediatric centers in the UK over a one-year period reveals a low incidence of pulmonary aspiration in both elective and emergency cases. All patients made a full recovery.

Mucopolysaccharidosis type I (Hurler syndrome) and anesthesia: the impact of bone marrow transplantation, enzyme replacement therapy, and fiberoptic intubation on airway management.

AIM: To assess the effect of bone marrow transplantation (BMT), enzyme replacement therapy (ERT), and a fiberoptic endotracheal intubation technique in patients with mucopolysaccharidosis type I (MPS I, Hurler syndrome). BACKGROUND: The mucopolysaccharidoses are inherited metabolic conditions with a well-documented association with difficult airway management. We present the largest series to date of patients with Hurler syndrome (MPS I) and look at the impact of new treatments, such as BMT and ERT, on anesthesia and airway management. METHODS/MATERIALS: We carried out a retrospective chart review of patients with MPSI undergoing anesthesia over 9 years at the Royal Manchester Children's Hospital. Data were collected on incidence of difficult and failed intubation and airway difficulties under anesthesia. RESULTS: There were 39 patients identified, of which 20 had the attenuated form of MPS I and received ERT, 18 were treated by BMT and one patient received neither treatment. These patients had a total of 114 general anesthetics for 141 procedures. The incidence of airway complications overall is lower than previously reported at 31%. Patients with the attenuated form of the disease on ERT still have a high incidence of airway problems at 57% and a failed intubation rate of 3%. BMT patients on the other hand have a much lower incidence of airway complications at 14%, and there were no failed intubations in this group. CONCLUSIONS: Managing the MPS1 patient continues to be a challenge but with treatment and newer forms of airway management it is improving.

The management of difficult intubation in children.

This article looks at the current techniques and equipment recommended for the management of the difficult intubation scenario in pediatric practice. We discuss the general considerations including preoperative preparation, the preferred anesthetic technique and the use of both rigid laryngoscopic and fiberoptic techniques for intubation. The unanticipated scenario is also discussed.

Regional anesthetic techniques are an alternative to general anesthesia for infants with Pompe's disease.

Pompe's disease or glycogen storage disease type II is a genetic disorder affecting skeletal and cardiac muscle. The infantile form is associated with gross hypertrophic cardiomegaly and death in the early years. General anesthesia is associated with potential major morbidity in these patients. We present our experience of regional anesthetic blocks used in five patients with the infantile form of glycogen storage disease type II with and without sedation for 11 surgical procedures during a clinical trial of replacement therapy for this condition. Both femoral nerve blockade and caudal epidural blockade were used with good result. The relative merits of the type of block are discussed in addition to the choice of sedation and risks of general anesthesia. The avoidance of general anesthesia in the newly presenting patient with Pompe's disease may reduce potential morbidity until enzyme replacement has been established.