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A generalized multistage approach to oral and nasal intubation in infants with Pierre Robin sequence: A retrospective review

机译：Pierre Robin序列中婴儿口腔和鼻插管的广义多级方法：回顾性评论

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Summary Background Airway management in children with Pierre Robin sequence in the infantile period can be challenging and frequently requires specialized approaches. Aims The aim of this study was to review our experience with a multistage approach to oral and nasal intubation in young infants with Pierre Robin sequence. Methods After IRB approval, we reviewed 13 infants with Pierre Robin sequence who underwent a multistage approach to intubation in the operating room for mandibular distractor or gastrostomy tube placement. All patients underwent awake placement of either an LMA‐Classic? #1 or ProSeal? laryngeal mask airway size #1. General anesthesia was induced with sevoflurane, and patients were relaxed with rocuronium. The laryngeal mask airway was replaced with an air‐Q ? 1.0. Children were then intubated through the air‐Q ? 1.0 using a flexible fiberoptic bronchoscope. In cases that required a nasotracheal tube, the oral tube was left in place while a flexible fiberoptic bronchoscope loaded with a similar internal diameter nasal Ring‐Adair‐Elwyn ( RAE ) tube was introduced into the nares. Once the scope was in proximity to the glottis, the oral tube was removed and the patient was intubated with the nasal RAE over the fiberscope. Results All 13 patients with Pierre Robin sequence were successfully intubated. We observed no periods of desaturation during placement and induction with the LMA‐Classic? or ProSeal? laryngeal mask airway except in one patient who was in extremis in the neonatal intensive care unit and required emergent transport to the operating room with the laryngeal mask airway in place. We observed several brief periods of desaturation during the apneas associated with fiberoptic intubation. Conclusion In conclusion, we were able to use a ventilation‐driven, multistaged approach using the unique properties of different supraglottic airways to facilitate oral and nasal intubation in 13 infants with Pierre Robin sequence.
机译：摘要背景技术在婴儿期间有皮埃尔罗宾序列的儿童的气道管理可能具有挑战性，并且经常需要专门的方法。目的这项研究的目的是审查我们的经验，以便与Pierre Robin序列的年轻婴儿口腔和鼻插管的多级方法。方法在IRB批准后，我们​​审查了13名婴儿，其中有13个婴儿，他们在手术室内完成了一个多级方法，在手术室内的颌下倾向或胃造影管放置。所有患者均接受LMA-CLASSIC的唤醒安置？ ＃1或proSeal？喉部面膜气道大小＃1。通过七氟醚诱导全身麻醉，患者用罗孔弛豫。喉部面膜气道被空气Q替换为？ 1.0。然后通过空中Q提交儿童？ 1.0使用柔性纤维支气管镜。在需要鼻腔管的情况下，将口腔管留在适当位置，同时载有类似的内径鼻环 - Adair-Elwyn（Rae）管的柔性纤维支气管镜被引入鼻内。一旦该范围靠近光泽，将移除口腔管，并将患者用鼻腔加管患者。结果所有13例皮埃尔罗宾序列患者都成功插管。在对LMA-Classic的放置和诱导期间，我们观察到了不饱和的时期？或proSeal？喉部面膜气道除了在新生儿重症监护手机上处于极端的一名患者，并要求喉部面膜气道的手术室出现紧急运输。在与纤维插管相关的呼吸暂停期间，我们观察了几个短暂的去饱和期。结论总结，我们能够使用不同的超级通气道的独特性质来使用通风驱动的多级方法，以促进13个婴儿的口腔和鼻管插管。

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