Pediatric otolaryngologic emergencies.

Anesthesiologists are often consulted to help in the management of pediatric otolaryngologic emergencies. These include airway obstruction in children suffering from acute epiglottitis and croup. Surgical otolaryngologic emergencies such as foreign body aspiration, post-tonsillectomy bleeding, obstructive laryngeal papillomatosis, peritonsillar abscess, and laryngeal trauma can be life threatening. The pathophysiology, clinical course, and anesthetic management of these conditions are addressed with special emphasis on the details of airway management in each case.

Fast-tracking children after ambulatory surgery.

UNLABELLED: This study was designed to determine the feasibility and benefits of fast-tracking children after ambulatory surgery. One-hundred-fifty-five healthy children undergoing surgical procedures lasting <90 min were studied in a randomized manner. After surgery, children who met predefined recovery criteria in the operating room were entered into one of the study groups. Seventy-one patients (control) were first admitted to the postanesthesia care unit (PACU) and then to the second-stage recovery unit (SSRU). Eighty-four children bypassed the PACU and were directly admitted to the SSRU (Fast-Track group). The demographic data, airway management, and surgical procedures were similar in both groups of patients. During the recovery phase, 62.0% of the PACU group patients and 40.5% of the Fast-Track patients received analgesics (P = 0.01). The total recovery time was 79.1 +/- 48.3 min in the Fast-Track group and 99.4 +/- 48.6 min in the Control group (P = 0.008). A larger percentage of parents in the Fast-Track group (31% vs 16%) reported that their child was restless on arrival at the SSRU (P = 0.037). There were no clinically significant adverse events. However, adequate pain control must be provided before transfer to SSRU. In conclusion, fast-tracking children after ambulatory surgery is feasible and beneficial when specific selection criteria are used. IMPLICATIONS: The results of this study show that the total recovery time is shorter in children who are fast-tracked (bypass the postanesthesia care unit) after ambulatory surgery. A higher percentage of parents of the Fast-Track group felt that their child was restless on arrival at the second-stage recovery unit. Fast-tracking children after ambulatory surgery is feasible and beneficial when specific selection criteria are used.

Comparison of three techniques for internal jugular vein cannulation in infants.

Central venous cannulation allows accurate monitoring of right atrial pressure and infusion of drugs during the anaesthetic management of infants undergoing cardiopulmonary bypass. In this prospective, randomized study, we compared the success and speed of cannulation of the internal jugular vein in 45 infants weighing less than 10 kg using three modes of identification: auditory signals from internal ultrasound (SmartNeedle, SM), external ultrasound imaging (Imaging Method, IM) and the traditional palpation of the carotid pulsation and other landmarks (Landmarks Method, LM). The cannulation time, number of attempts with LM and SM techniques were greater than those with IM technique. The incidence of carotid artery puncture and the success rate were not significantly different among the three groups. In infants, a method based on visual ultrasound identification (IM) of the internal jugular vein is more precise and efficient than methods based on auditory (SM) and tactile perception (LM).

Ultrasound-guided internal jugular venous cannulation in infants: a prospective comparison with the traditional palpation method.

BACKGROUND: Percutaneous cannulation of the internal jugular vein in infants is technically more difficult and carries a higher risk of carotid artery puncture than in older children and adults. In this prospective study, the authors tested their hypothesis that using an ultrasound scanner would increase the success of internal jugular cannulation and decrease the incidence of carotid artery puncture in infants. METHODS: After approval from the institutional review board and receipt of written informed parental consent, 95 infants scheduled for cardiac surgery were randomized prospectively into two groups. In the landmarks group, the patients' internal jugular veins were cannulated using the traditional method of palpation of carotid pulsation and identification of other anatomic landmarks. In the ultrasound group, cannulation was guided using an ultrasound scanner image. The cannulation time, number of attempts, success rate, and incidence of complications were compared for the two groups. RESULTS: There were no significant differences between the two groups with regard to weight, age, and American Society of Anesthesiologists physical status classification. The success rate was 100% in the ultrasound group, with no carotid artery punctures, and 77% in the landmarks group, with a 25% incidence of carotid artery punctures. Both differences were significant (P > 0.0004). The cannulation time was less, the number of attempts was fewer, and the failure rate was significantly lower in the ultrasound group than in the landmark group. CONCLUSION: Ultrasonographic localization of the internal jugular vein was superior to the landmarks technique in terms of overall success, speed, and decreased incidence of carotid artery puncture.

Emergence airway complications in children: a comparison of tracheal extubation in awake and deeply anesthetized patients.

We compared the differences in oxygen saturation and airway-related complications after tracheal extubation in pediatric patients undergoing elective strabismus surgery or adenoidectomy and/or tonsillectomy who were awake versus anesthetized. Seventy otherwise healthy patients between 2 and 8 yr of age were studied. Anesthesia was induced with halothane or thiamylal and maintained with nitrous oxide and halothane. After induction of anesthesia, the patients were randomly assigned to group 1 (awake extubation) or group 2 (anesthetized extubation). Oxygen saturation was measured continuously and recorded 10 min before extubation and at 1, 2, 3, 5, 7, 10, 15, 20, 25, and 30 min after tracheal extubation. Supplemental oxygen was administered when oxygen saturation values were less than 90% while breathing room air. Oxygen saturation levels were higher in group 2 than in group 1 at 1, 2, 3, and 5 min after extubation. There were no differences between the two groups in the number of patients requiring supplemental oxygen. The incidence of airway-related complications such as laryngospasm, croup, sore throat, excessive coughing, and arrhythmias was not different between the two groups. We conclude that the anesthesiologist's preference or surgical requirements may dictate the choice of extubation technique in otherwise healthy children undergoing elective surgery.