Predicting endotracheal tube size from length: Evaluation of the Broselow tape in Indian children.

BACKGROUND AND AIMS: Several formulae are available to estimate endotracheal tube (ETT) size in children. This study was designed to compare the ETT estimated by the Broselow tape (BT) with age-based estimation of ETT size and to identify the most accurate formula for the prediction of uncuffed ETT size in Indian children. MATERIAL AND METHODS: Pediatric patients aged 1 month-6.5 years undergoing emergency or elective surgery under general anesthesia requiring endotracheal intubation with uncuffed ETT were included in this study. The ETT size was selected based on the age formula (Penlington formula). The ETT used was deemed to be of correct fit based on the delivery of adequate tidal volume and presence of minimal leak at 20 cm H2O. The actual ETT used was compared with that predicted by age, length of the child, BT, and fifth fingernail width of the child using Pearson's correlation. RESULTS: In children aged <6 months, the ETT used was found to correlate with length (r = 0.286, P = 0.044) and finger nail width (r = 0.542, P < 0.001) of the children. In children >6 months, the ETT used correlated with that predicted from age, BT, length, and fingernail width of the children. In our study, BT has an overall correct predictability rate of 50.3% whereas the age-based formula has a correct prediction rate of 59.8% and length-based formula is 48.7% accurate. CONCLUSION: Length of the child has a good correlation with size of the ETT to be used in Indian children across all age groups. BT is an effective tool to predict ETT size in children >6 months.

Comparison of Second-Generation Supraglottic Airway Devices (i-gel versus LMA ProSeal) During Elective Surgery in Children.

Second-generation supraglottic airway devices i-gel (Intersurgical Ltd) and LMA ProSeal (Teleflex Inc) are designed for a superior airway seal with a high success rate in adults. This study compared the efficacy of i-gel and LMA ProSeal (sizes 1, 1.5, and 2) as an airway device in a pediatric population, especially infants. The study included 163 ASA class 1 and 2 children, aged up to 10 years and weighing 2 to 25 kg, undergoing elective surgeries lasting less than 1 hour under general anesthesia on spontaneous respiration. Participants were randomly assigned to 2 groups: i-gel and LMA ProSeal. With each device, the ease of insertion, time of insertion, manipulations required for placement of the device, and oropharyngeal leak pressure were recorded. A lubricated gastric tube of the recommended size was passed through each device, and ease of insertion was noted. At the end of surgery, the device was removed and complications were noted, including laryngospasm, breath holding, and blood-stains. Mann-Whitney U test and χ2 tests were used to compare collected data. Both devices were found to be comparable in effectively securing the airway in children, even in infants. The insertion time was significantly faster with i-gel.

Airway management of a child with frontometaphyseal dysplasia (Gorlin Cohen syndrome).

Frontometaphyseal dysplasia (FMD), also called Gorlin-Cohen syndrome, is a rare hereditary X-linked dominant craniotubular bone disorder. The presentation describes the airway management of a 2-year-old child suffering from FMD with significant retrognathia, posted for major long bone corrective osteotomy. Induction with a combination of dexmedetomidine and ketamine preceded a successful endotracheal intubation under spontaneous ventilation.

Fatal hyperkalemia following succinylcholine administration in a child on oral propranolol.

Succinylcholine is one of the most commonly used drugs by anesthesiologists worldwide for rapid access to airway both in emergency and elective situations. Nonetheless, the very mention of succinylcholine generates the most energetic high decibel debate between its users and nonusers. Despite its potential to produce a short-acting, ultra-intense neuromuscular block rapidly in seconds, it is surrounded by a plethora of side effects and drug interactions. This case report is about one such drug interaction of this innocent yet malicious drug, which resulted in the death of a 14-year-old girl. Both ß-adrenergic blockers and succinylcholine are known to cause hyperkalemia. Life-threatening hyperkalemia in susceptible individuals who have been administered succinylcholine has the most severe effect on the myocardium and can result in asystole with minimal chances of resuscitation. Both succinylcholine and a nonselective ß-adrenergic blocker, propranolol, have the propensity to affect the transcellular redistribution of potassium which can result in hyperkalemia. We advocate cautious use of this drug combination till further studies confirm the drug interaction and find the potential triggering factors involved.