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Airway Anatomy (airway + anatomy)
Selected AbstractsPrenatal and early postnatal morphogenesis and growth of human laryngotracheal structuresJOURNAL OF ANATOMY, Issue 2 2008Pierre Fayoux Abstract Advances in neonatal medicine have resulted in increased care of fetal and neonatal airways. These advances have required an exhaustive knowledge of fetal airway anatomy and development. The aim of this study was to determine the anatomical development of laryngotracheal structures during the fetal and immediate postnatal period and to correlate these observations with other fetal biometric parameters to estimate developmental particularities of the fetal airway. An anatomical prospective study was based on examination of larynx and trachea from 300 routine autopsies of fetuses and infants, free of malformation and never intubated. Anatomical measurements of cricoid cartilage, thyroid cartilage, glottis, arytenoid cartilage and trachea were performed using a precision calliper and precision divider. Statistical analysis was performed to represent the growth of anatomical structures and to evaluate the correlation with biometric data. Raw data and 10th and 90th percentile curves were fitted satisfactorily with a linear model for gestational age. A linear relationship between laryngotracheal measurement and body weight and height was observed except for glottis length, interarytenoid distance and anterior cricoid height. The diameter of the cricoid lumen was significantly less than that of the trachea and glottis lumen. A sexual dysmorphism was noted for thyroid cartilage measurements and interarytenoid distance, with measurements significantly smaller in females. This study reports the anatomical development of normal laryngotracheal structures during the fetal period. Despite the fact that this study was performed during postmortem examination, these observations can be useful to develop criteria, materials and surgical procedures adapted to fetal and neonatal airways as well as for the purposes of early diagnosis and management of laryngotracheal malformations. [source] Awake tracheal intubation using the Airtraq® laryngoscope: a case seriesACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 7 2009V. K. DIMITRIOU The Airtraq® laryngoscope (AL) is a new single use indirect laryngoscope designed to facilitate tracheal intubation in anaesthetised patients either with normal or difficult airway anatomy. It is designed to provide a view of the glottis without alignment of the oral, pharyngeal and tracheal axes. We report four cases of successful awake tracheal intubation using the AL. The first case is a patient with severe ankylosing spondylitis and the other three cases with anticipated difficult airway. An awake intubation under sedation and topical airway anaesthesia was chosen. We consider that the AL can be used effectively to accomplish an awake intubation in patients with a suspected or known difficult airway and may be a useful alternative where other methods for awake intubation have failed or are not available. [source] Dosage regimens for inhaled therapy in children should be reconsideredJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 2 2002JH Wildhaber Abstract: In current asthma guidelines, dosage regimens for inhalation therapy in children are based on adult doses and are generally titrated per kilogram of bodyweight or per square metre of body surface area. However, these recommendations do not correspond well with current knowledge of aerosol therapy in childhood. Lung deposition of the aerosolised drug is the key determinant for clinical efficacy and for systemic side effects of inhalation therapy. Lung deposition increases with age, whereas lung deposition expressed as a percentage per kilogram bodyweight is age-independent. This finding is explained by the self-regulating effect of age-dependent airway anatomy on lung deposition. Therefore, it is more likely that adult doses translate into paediatric doses only by virtue of the differences in self-limiting pulmonary deposition when using the same absolute nominal doses of the medication. Adapting the adult dose to a paediatric dose calculated on body size might be unnecessary and could lead to insufficient pulmonary deposition of medication. These findings suggest that dosage regimens for inhalation therapy for children may have to be reconsidered, and should be determined from dose-ranging studies rather than calculated from adult doses based on body size. [source] A comparison of the STORZ video laryngoscope and standard direct laryngoscopy for intubation in the Pediatric airway , a randomized clinical trialPEDIATRIC ANESTHESIA, Issue 11 2009ARNIM VLATTEN MD Summary Introduction:, Direct laryngoscopy can be challenging in infants and neonates. Even with an optimal line of sight to the glottic opening, the viewing angle has been measured at 15°. The STORZ DCI video laryngoscope (Karl Storz, Tuttlingen, Germany) incorporates a fiberoptic camera in the light source of a standard laryngoscope of variable sizes. The image is displayed on a screen with a viewing angle of 80°. We studied the effectiveness of the STORZ DCI as an airway tool compared to standard direct laryngoscopy in children with normal airway. Methods:, In this prospective, randomized study, 56 children (ages 4 years or younger) undergoing elective surgery with the need for endotracheal intubation were divided into two groups: children who underwent standard direct laryngoscopy using a Miller 1 or Macintosh 2 blade (DL) and children who underwent video laryngoscopy using the STORZ DCI video laryngoscope with a Miller 1 blade (VL). Time to best view (TTBV), time to intubate (TTI), Cormack,Lehane (CL), and percentage of glottis opening seen (POGO) score were recorded. Results:, TTBV in DL was 5.5 (4,8) s and 7 (4.2,9) s in VL. TTI in DL was 21 (17,29) s and in VL 27 (22,37) s (P = 0.006). The view as assessed by POGO score was 97.5% (60,100%) in DL and 100% (100,100%) in the VL (P = 0.003). Data are presented as median and interquartile range and analyzed using t -test. Discussion:, This study demonstrates that the STORZ DCI video laryngoscope provides an improved view to the glottis in children with normal airway anatomy, but requires a longer time for intubation. [source] The science of aerosol delivery in cystic fibrosisPEDIATRIC PULMONOLOGY, Issue S9 2008David E. Geller MD Abstract Aerosolized drugs are universally used for treatment of cystic fibrosis airway disease. Inhalation can increase topical efficacy and reduce systemic exposure and toxicity of many drugs. A wide variety of inhaled drugs already exist with many more in the therapeutic pipeline. Understanding the principles of aerosol delivery and how aerosol devices function is important in designing the best therapeutic regimens for CF patients. The variables that determine where an aerosol deposits are numerous and complex. Important aerosol-related variables include particle-size distribution, hygroscopic properties, viscosity and surface tension of the drug. Patient-related variables include inspired flow rate, tidal volume, respiratory rate, breath-holding, upper airway anatomy, lower airways obstruction, and the cognitive and physical ability to use the device. These factors vary widely between patients of different age groups and disease severities, and cause the high variability in drug delivery seen with aerosol drugs. Classic aerosol delivery devices like metered dose inhalers and dry-powder inhalers are small, portable, and have short treatment times. However, they are limited by small drug payloads and user technique problems. Jet nebulizers are commonly used for CF drugs, are easy to operate, require no special breathing pattern, and can deliver very large quantities of drug. However, they require a power or air source, cleaning and sanitizing, and are relatively time consuming. Recently, novel aerosol delivery systems and formulations have been developed to improve delivery efficiency and reduce variability and delivery time. These new systems can ease the treatment burden and improve adherence and outcomes in cystic fibrosis. Pediatr Pulmonol. 2008; 43:S5,S17. © 2008 Wiley-Liss, Inc. [source] Randomised comparison of Pentax AirwayScope and Glidescope for tracheal intubation in patients with normal airway anatomyANAESTHESIA, Issue 10 2009W. H. L. Teoh Summary We compared intubating characteristics of the Pentax AirwayScope and Glidescope in a randomised controlled trial involving 140 patients. We found significantly shorter intubation times with mean (SD) 21.3 (12.3) vs 30.2 (13.2) s, lower intubating difficulty scores 4.4 (10.4) vs 12.8 (16.3) p < 0.001, and better grade 1 laryngeal views with the Pentax AirwayScope (95.7 vs 81.4%, p = 0.015). Significantly more optimisation manoeuvres were needed to successfully intubate with the Glidescope, with significant inability to align the tip of the tracheal tube with the glottic opening with the Glidescope in 9 (13%) vs no patients, p = 0.013. There was more mucosal bleeding (4 (5.7%) vs 1 (1.4%), p = 0.366), more lip bleeding (3 (4.3%) vs 1 (1.4%), p = 0.620) and significantly more postoperative sorethroat, 13 (18.6%) vs 0, p < 0.001 associated with the Glidescope. [source] | ||||||||||