Videolaryngoscopy versus direct laryngoscopy for tracheal intubation in neonates.

BACKGROUND: Establishment of secure airway is a critical part of neonatal resuscitation both in the delivery room and in the neonatal unit. Videolaryngoscopy is a new technique that has the potential to facilitate successful endotracheal intubation and decrease adverse consequences of delay in airway stabilization. Videolaryngoscopy may enhance visualization of the glottis and intubation success in neonates. OBJECTIVES: To determine the efficacy and safety of videolaryngoscopy compared to direct laryngoscopy in decreasing the time and attempts required and increasing the success rate for endotracheal intubation in neonates. SEARCH METHODS: We used the search strategy of the Cochrane Neonatal Review Group. We searched for randomized controlled trials evaluating videolaryngoscopy for neonatal endotracheal intubation in May 2013 in the electronic databases; the Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; EMBASE; CINAHL; abstracts of the Pediatric Academic Societies; websites for registered trials at www.clinicaltrials.gov and www.controlled-trials.com; and in the reference lists of relevant studies. SELECTION CRITERIA: Randomized or quasi-randomized trials in neonates evaluating videolaryngoscopy for endotracheal intubation compared with direct laryngoscopy. DATA COLLECTION AND ANALYSIS: Review authors performed data collection and analysis as recommended by the Cochrane Neonatal Review Group. Two review authors (KL and MP) independently assessed studies identified by the search strategy for inclusion. MAIN RESULTS: Our search strategy performed in May 2013 yielded 7057 references. Two review authors (MP and KL) independently assessed all references for inclusion. We did not find any completed studies for inclusion but identified three ongoing trials and one study awaiting classification. AUTHORS' CONCLUSIONS: There was insufficient evidence to recommend or refute the use of videolaryngoscopy for endotracheal intubation in neonates. Well-designed, adequately powered randomized controlled studies are necessary to address efficacy and safety of videolaryngoscopy for endotracheal intubation in neonates.

Blood loss, replacement, and associated morbidity in infants and children undergoing craniofacial surgery.

BACKGROUND: Pediatric craniofacial reconstruction (CFR) procedures involve wide scalp dissections with multiple osteotomies and have been associated with significant morbidity. The aim of this study was to document the incidence of clinically important problems, particularly related to blood loss, and perform a risk factor analysis. METHODS: Records of all patients who underwent craniofacial surgery at the Children's Hospital of Philadelphia between December 1, 2001 and January 1, 2006 were reviewed. Data were collected from the electronic anesthesia record, intensive care unit (ICU) progress notes, and discharge summary. All intraoperative laboratory values and all laboratory values obtained upon arrival in the ICU were recorded. A multivariable analysis was performed to evaluate associations between elements of intraoperative management and the following clinical outcomes: intraoperative hypotension, intraoperative metabolic acidosis, presence of a postoperative coagulation test abnormality, and postoperative administration of hemostatic blood products. RESULTS: Data for 159 patients were reviewed. The mean volume of packed red blood cells transfused intraoperatively was 51 ml x kg(-1). Multivariable analysis revealed that intraoperative administration of albumin was strongly correlated with both an increased incidence of postoperative coagulation derangements and postoperative administration of hemostatic blood products (Odds Ratio 5.9, 2.8, respectively), while intraoperative fresh frozen plasma (FFP) administration was associated with an opposite effect (Odds Ratio 0.94, 0.97, respectively). CONCLUSIONS: In pediatric CFR procedures where the volume of blood loss routinely exceeds one blood volume, intraoperative administration of FFP favorably impacted postoperative laboratory coagulation parameters.