ABSTRACT
PURPOSE OF REVIEW: There is a large variation in the methods and techniques used to secure the airway in children for the purposes of diagnosis and surgery. This review gives an idea of the different ways through which this can be achieved. RECENT FINDINGS: Studies of new devices such as laryngoscopes and the use of the laryngeal mask are changing how some approach the paediatric airway. Other aspects such as safety have recently achieved greater prominence. SUMMARY: There is still no consensus on how to manage these patients. Each centre has evolved a system that works for them. However, the common themes of communication between team members, attention to detail and a high level of awareness of problems run through all the articles quoted here.
Subject(s)
Airway Management , Anesthesia/methods , Child , Humans , Hypoxia/prevention & control , Laryngeal Masks , Laryngoscopes , Preoperative Care , Respiration, ArtificialABSTRACT
Anesthesia for laser surgery in children carries a number of particular challenges and pitfalls. The anesthetist must be aware not only of the problems of anesthetizing a patient with a potentially compromised airway but also of how to maintain homeostasis when surgery is taking place, as procedures may make a bad situation temporarily worse. Personnel must also be very aware of the benefits and dangers of medical lasers, and what safety precautions must be taken to ensure their proper use. This section will deal with the properties of lasers, how and why they are used, and a description of how these procedures are carried out in our own institution.
Subject(s)
Anesthesia , Laser Therapy , Anesthesia Recovery Period , Anesthesia, Inhalation , Burns/prevention & control , Child , Child, Preschool , Humans , Infant , Infant, Newborn , Intraoperative Complications/prevention & control , Laryngoscopy , Lasers/adverse effects , Patient Discharge , Respiratory System/anatomy & histologyABSTRACT
A carbon dioxide laser was used through a bronchoscope to split the posterior aspect of complete tracheal rings in the distal trachea of a 16-month-old boy previously palliated for cyanotic congenital heart disease. After laser division of the complete tracheal rings, the patient was successfully extubated. Subsequently, the boy had granulation tissue develop, which required bronchoscopic resection, and then severe posterior tracheal impingement developed from the esophageal herniation, which required placement of a distal tracheal stent. Although unsuccessful in this case, carbon dioxide laser division of complete tracheal rings may be a safe and effective method of treating congenital tracheal stenosis in selected cases.