Challenge to pediatric anatomical variation : Can we draw the ideal line on the pediatric I-gel?

Objective: I-gel is a noncuff type of laryngeal airway mask. No horizontal line has yet been determined as an ideal position for pediatric sizes because of the variability in length of the oropharyngeal-laryngeal arch in children. We investigated whether there is a correlation between insertion length and patient body weight or height for the pediatric I-gel sizes from 1.

Changes of epidural blood flow after epidural administration of epinephrine in young rats.

Purpose: For caudal epidural analgesia, the needle is inserted at a site where vessels are abundant. To avoid complications related to intravascular administration of the local anesthetic, epinephrine is usually added, but there is no evidence about the safety of epidural administration of epinephrine in pediatric patients. The objective of this study was to assess the changes in epidural blood flow after epidural injection of epinephrine in young rats.

Ultrasound versus anatomical landmarks for caudal epidural anesthesia in pediatric patients.

Background: Caudal block is easily performed because the landmarks are superficial. However, the sacral hiatus is small and shallow in pediatric patients. In the present study, we evaluated under general anesthesia whether the distance between the bilateral superolateral sacral crests increased with growth, whether an equilateral triangle was formed between the apex of the sacral hiatus and the bilateral superolateral sacral crests, and whether expansion of the epidural space could be confirmed by ultrasound.

Initial experience of the i-gel supraglottic airway by the residents in pediatric patients.

Purpose: Insertion of a laryngeal mask airway (LMA) is occasionally difficult in children because of their anatomical features and variations. A new single-use supraglottic airway device, the i-gel airway, was recently introduced. The objective of this study was to show the initial experience of the i-gel airway device by the residents for pediatric patients.

[Anesthetic management for laryngoscopic evaluation of upper airway stenosis using our modified endoscopic mask].

Young children are at increased risk for hypoxaemia and hypercapnea during flexible laryngoscopy due to the small size and increased collapsibility of their airways. To evaluate upper airway stenosis of a 5-year-old girl presenting with retractive inspiratory breathing, we developed a modified endoscopy mask consisting of a regular face mask where the original port for endoscope was replaced by a disposable rubber dam. This setting allows a leak-free passage of both nasal and oral endoscopy and enables emergent endoscopic intubation through a small hole of a rubber dam.

The carina is not a landmark for central venous catheter placement in neonates.

Background: Cardiac tamponade is rare but one of the most serious complications in relation to central venous catheters (CVC). The tip of the CVC should be placed outside the pericardium to avoid tamponade. In adults, the carina is always located above the pericardium; therefore, the carina is a reliable landmark for CVC placement.

[Anesthetic management for a child with pompe disease].

Pompe or glycogen storage disease type II is a genetic disorder affecting the cardiac and skeletal muscle. A 4-year-old boy with this disease was scheduled to undergo an orthopedic operation for clubbed foot. He had cardiomyopathy and skeletal muscle weakness; but his cardiac function was normalized by the long-term enzyme replacement therapy.

[The management of the difficult pediatric airway].

Background: We are faced sometimes with the difficult pediatric airway due to congenital abnormalities. However, there has been no systematic examination for the management of the difficult pediatric airway.

Methods: We retrospectively examined the incidence of difficult airway in 13,557 pediatric patients who had undergone general anesthesia with tracheal intubation.

A comparison of five techniques for detecting cardiac activity in infants.

Background: The new guidelines for cardiopulmonary resuscitation recommend that laypersons should begin chest compressions without checking for a pulse because the pulse check has serious limitations in accuracy. We determined the efficacy of the most suitable method to search for cardiac activity in infants.

Methods: Twenty-eight nurses tried to detect infants' cardiac activity and determined their heart rates with five different techniques: palpation of brachial pulse, carotid pulse, femoral pulse, apical impulse and auscultation of apical impulse with the naked ear (direct auscultation technique).

Higher airway seal does not imply adequate positioning of laryngeal mask airways in paediatric patients.

Background: It has been generally accepted that a higher airway seal pressure indicates adequate positioning of the laryngeal mask airway (LMA) in adult patients. The present study was undertaken to clarify whether a higher airway seal pressure correlates with an adequate positioning of the LMA in paediatric patients.

Methods: One hundred and eighty-one healthy children, aged 6-121 months, weighing 7.