A prospective observational study of video laryngoscopy-guided coaching in the pediatric intensive care unit.

Background: There are limited data on the use of video laryngoscopy for pediatric patients outside of the operating room.

Aim: Our primary aim was to evaluate whether implementation of video laryngoscopy-guided coaching for tracheal intubation is feasible with a high level of compliance and associated with a reduction in adverse tracheal intubation-associated events.

Methods: This is a pre-post observational study of video laryngoscopy implementation with standardized coaching language for tracheal intubation in a single-center, pediatric intensive care unit.

Practice what you teach: An approach to integrate airway education for experienced anesthesia clinicians.

Background: The COVID-19 pandemic has disrupted clinician education. To address this challenge, our divisional difficult airway program (AirEquip) designed and implemented small-group educational workshops for experienced clinicians. Our primary aim was to test the feasibility and acceptability of a small-group, flexible-curriculum skills workshop conducted during the clinical workday.

Intracranial Hypertension in Multisystem Inflammatory Syndrome in Children.

Multisystem inflammatory syndrome in children (MIS-C) is characterized by fever and multiorgan system dysfunction. Neurologic complications of MIS-C are not well described. We present 4 patients with MIS-C who had intracranial hypertension and discuss the unique management considerations when this occurs concurrently with significant myocardial dysfunction.

Full Finger Reperfusion Time Measured by Pulse Oximeter Waveform Analysis in Children.

Objectives: Capillary refill time is a noninvasive method to assess tissue perfusion to determine shock status. Capillary refill time is defined as the time required to regain skin color after blanching pressure is applied. Although common methods to measure capillary refill time depend on clinicians' visual assessment, a new approach using a pulse oximeter waveform analysis exists, referred to as full finger reperfusion time.

Difficult Bag-Mask Ventilation in Critically Ill Children Is Independently Associated With Adverse Events.

Objectives: Bag-mask ventilation is commonly used prior to tracheal intubation; however, the epidemiology, risk factors, and clinical implications of difficult bag-mask ventilation among critically ill children are not well studied. This study aims to describe prevalence and risk factors for pediatric difficult bag-mask ventilation as well as its association with adverse tracheal intubation-associated events and oxygen desaturation in PICU patients.

Design: A retrospective review of prospectively collected observational data from a multicenter tracheal intubation database (National Emergency Airway Registry for Children) from January 2013 to December 2018.

Getting to know a familiar face: Current and emerging focused ultrasound applications for the perioperative setting.

Ultrasound technology is available in many pediatric perioperative settings. There is an increasing number of ultrasound applications for anesthesiologists which may enhance clinical performance, procedural safety, and patient outcomes. This review highlights the literature and experience supporting focused ultrasound applications in the pediatric perioperative setting across varied disciplines including anesthesiology.

Anesthetic Management for Pediatric Awake Tracheostomy.

Awake tracheostomy is indicated for acute upper airway obstruction, when other methods of securing the airway, such as intubation and cricothyrotomy, have failed or are inappropriate. This option is rarely considered in pediatrics because of the concerns of patient cooperation and safety and has not been described in the literature. We describe the anesthetic management of an awake tracheostomy performed on a 7-year-old girl, with a large supraglottic mass obstructing the laryngeal introitus.

Anesthetic Management for Laser Excision of Ball-Valving Laryngeal Masses.

A 47-year-old obese woman with GERD and COPD presents for CO2-laser excision of bilateral vocal fold masses. She had a history of progressive hoarseness and difficulty in breathing. Nasopharyngeal laryngoscopy revealed large, mobile, bilateral vocal cord polyps that demonstrated dynamic occlusion of the glottis.