A cohort evaluation of the pediatric ProSeal laryngeal mask airway in 100 children

Background: The ProSeal^® laryngeal mask airway (PLMA) has been available in pediatric sizes in the UK since 2007. Although several non‐UK studies have evaluated PLMAs in children, there are little published data regarding their use in this country. Having decided to introduce the pediatric PLMA into our practice, we chose to prospectively audit the first 100 uses as part of our clinical governance. Methods: We studied children undergoing elective surgery who were considered suitable for a supraglottic airway. We recorded patient, surgical and insertion details, device performance data and complications. Patient management was not altered by inclusion in this audit. Results: Twenty size 1.5, 55 size 2.0, 15 size 2.5 and 10 size 3.0 PLMAs were inserted in 100 consecutive children [median age 2 years (range 2 months to 10 years) and median weight 15 kg (range 4.9–60 kg)]. The overall first attempt success rate was 93% (size 1.5, 100%; size 2.0, 100%; size 2.5, 87%; size 3.0, 90%) and overall successful insertion rate was 99%. Median leak pressure was 25 cmH₂O. Outright failure was seen in one patient; complications were seen in another six patients (partial airway obstruction in five patients and mild laryngospasm in one patient), all of whom were transient and none of whom required intubation. No episodes of regurgitation were recorded. Conclusions: Even without prior experience and using nonconventional insertion, pediatric PLMAs (including size 1.5) can be easily inserted and provide an effective airway.     

Upper airway size and configuration during propofol-based sedation for magnetic resonance imaging: an analysis of 138 infants and children

Background: Propofol is widely used for pediatric sedation. However, increasing depth of propofol sedation is associated with airway narrowing and obstruction. The aim of this study was to objectively assess airway patency during a low‐dose propofol‐based sedation regimen by measuring upper airway size and configuration with magnetic resonance imaging (MRI) in spontaneously breathing infants and children. Methods: Magnetic resonance images of the upper airway were obtained in 138 infants and children, aged up to 6 years. Cross‐sectional area, anteroposterior dimension, and transverse dimension were measured at the level of the soft palate, the base of the tongue, and the tip of the epiglottis. Sedation was induced with i.v. midazolam 0.1 mg·kg^?1, nalbuphine 0.1 mg·kg^?1, and propofol 1 mg·kg^?1 and maintained with propofol 5 mg·kg^?1·h^?1. Results: Median (IQR) age was 36 (15, 48) months, and mean body weight was 13.7 ± 5.6 kg. Airway patency was maintained in all infants and children. The narrowest part of the pharyngeal airway was measured at the level of the base of the tongue. Anteroposterior dimensions were narrower than transverse dimensions in all age groups at all measurement sites. Transverse dimensions increased with age at all measurement sites, while anteroposterior dimensions did not increase comparably. No patient demonstrated respiratory or cardiovascular adverse events. All MRI were completed successfully without sedation failure. Conclusion: Airway patency was maintained in all infants and children sedated with this low‐dose propofol‐based sedation regimen.     

A network meta‐analysis of the clinical properties of various types of supraglottic airway device in children

We conducted both conventional pairwise and Bayesian network meta‐analyses to compare the clinical properties of supraglottic airway devices in children. We searched six databases for randomised clinical trials. Our primary end‐points were oropharyngeal leak pressure, risk of insertion failure at first attempt, and blood staining risk. The risk of device failure, defined as the abandonment of the supraglottic airway device and replacement with a tracheal tube or another device, was also analysed. Sixty‐five randomised clinical trials with 5823 participants were identified, involving 16 types of supraglottic airway device. Network meta‐analysis showed that the i‐gel?, Cobra perilaryngeal airway? and Proseal laryngeal mask airway (LMA^®‐Proseal) showed statistically significant differences in oropharyngeal leak pressure compared with the LMA^®‐Classic, with mean differences (95% credible interval, CrI) of 3.6 (1.9–5.8), 4.6 (1.7–7.6) and 3.4 (2.0–4.8) cmH₂O, respectively. The i‐gel was the only device that significantly reduced the risk of blood staining of the device compared with the LMA‐Classic, with an odds ratio (95%CrI) of 0.46 (0.22–0.90). The risk (95%CI) of device failure with the LMA‐Classic, LMA^®‐Unique and LMA‐Proseal was 0.36% (0.14–0.92%), 0.49% (0.13–1.8%) and 0.50% (0.23–1.1%), respectively, whereas the risk (95%CI) of the i‐gel and PRO‐Breathe was higher, at 3.4% (2.5–4.7%) and 6.0% (2.8–12.5%), respectively. The risk, expressed as odds ratio (95%CrI), of insertion failure at first attempt, was higher in patients weighing < 10 kg at 5.1 (1.6–20.1). We conclude that the LMA‐Proseal may be the best supraglottic airway device for children as it has a high oropharyngeal leak pressure and a low risk of insertion. Although the i‐gel has a high oropharyngeal leak pressure and low risk of blood staining of the device, the risk of device failure should be evaluated before its routine use can be recommended.     

Uso de videolaringoscópio para intubação traqueal em paciente com massa tumoral na cavidade oral: relato de caso

Background and objectivesWhen planning the management of a predicted difficult airway, it is important to determine which strategy will be followed. Video laryngoscopy is a major option in scenarios with factors suggesting difficult airway access. It is also indicated in rescue situations, when there is tracheal intubation failure with direct laryngoscopy. The objective of the present report was to show the efficacy of using the video laryngoscope as the first device for a patient with a large tumor that occupied almost the entire anterior portion of the oral cavity.Case report85 year‐old male patient, 162 cm, 70 kg, physical status ASA II, Mallampati IV classification, was scheduled for resection of an angiosarcoma located in the right maxillary sinus that invaded much of the hard palate and the upper portion of the oropharynx. He was conscious and oriented, with normal blood pressure, heart and respiratory rates and, despite the large tumor in the oral cavity; he showed no signs of respiratory failure or airway obstruction. After intravenous cannulation and monitoring, sedation was performed with 1 mg of intravenous midazolam, and a nasal cannula was placed to provide oxygen, with a flow of 2 L.min^‐1. Then, the target‐controlled infusion of remifentanil with an effect site concentration of 2 ng.mL^‐1 was initiated, according to Minto's pharmacokinetic model. Ventilation was maintained spontaneously during airway handling. A trans cricothyroid block was performed, with 8 mL of 1% lidocaine solution injected into the tracheal lumen. Slight bleeding did not prevent the use of an optical method for performing tracheal intubation. The entire oral cavity was sprayed with 1% lidocaine. The McGraph video laryngoscope with the difficult intubation blade was used, and an armored tube with a guide wire inside was used for tracheal intubation, performed on the first attempt with appropriate glottis visualization.ConclusionThe video laryngoscope occupies a prominent position in cases in which access to the airway is difficult. In the present case it was useful. It can be used as first choice or as a rescue technique. The video laryngoscope is an appropriate alternative and should be available for facing the ever‐challenging difficult airway patient.     

Emerging trends,techniques, and equipment for airway management in pediatric patients

Pediatric patients present unique anatomic and physiologic considerations in airway management, which impose significant physiologic limits on safe apnea time before the onset of hypoxemia and subsequent bradycardia. These issues are even more pronounced for the pediatric difficult airway. In the last decade, the development of pediatric sized supraglottic airways specifically designed for intubation, as well as advances in imaging technology such that current pediatric airway equipment now finally rival those for the adult population, has significantly expanded the pediatric anesthesiologist's tool kit for pediatric airway management. Equally important, techniques are increasingly implemented that maintain oxygen delivery to the lungs, safely extending the time available for pediatric airway management. This review will focus on emerging trends and techniques using existing tools to safely handle the pediatric airway including videolaryngoscopy, combination techniques for intubation, techniques for maintaining oxygenation during intubation, airway management in patients at risk for aspiration, and considerations in cannot intubate cannot oxygenate scenarios.     

The design of the perfect pediatric supraglottic airway device

The design evolution of the pediatric supraglottic airway device has experienced a long and productive journey. We have a wealth of clinical studies to support progress and advancements in pediatric clinical practice. While all of the  supraglottic airway devices have been used successfully in millions of children, it is important to be aware of design advantages and disadvantages of the different models of  supraglottic airway devices. Current pediatric supraglottic airway devices may be improved in design to be more ideal. Industry‐changing technological advancements are likely to occur in the near future, which may further improve clinical performance of these devices.     

Proposal for the management of the unexpected difficult pediatric airway

The incidence of unanticipated difficult or failed airway in otherwise healthy children is rare, and routine airway management in pediatric patients is easy in experienced hands. However, difficulties with airway management in healthy children are not infrequent in nonpediatric anesthetists and are a main reason for pediatric anesthesia‐related morbidity and mortality. Clear concepts and strategies are, therefore, required to maintain oxygenation and ventilation in children. Several complicated algorithms for the management of the unanticipated difficult adult and pediatric airway have been proposed, but a simple structured algorithm for the pediatric patient with unanticipated difficult airway is missing. This paper proposes a simple step‐wise algorithm for the unexpected difficult pediatric airway based on an adult Difficult Airway Society (DAS) protocol, discusses the role of recently introduced airway devices, and suggests a content of a pediatric airway trolley. It is intended as an easy to memorize and a practical guide for the anesthetist only occasionally involved in pediatric anesthesia care as well as a call to stimulate discussion about the management of the unanticipated difficult pediatric airway.     

Prospective model-based comparison of different laryngoscopes for difficult intubation in infants

Background: Difficult intubation in infants is uncommon but may be a challenge for the anesthesiologist. Many optical‐assisted techniques are available to ease endotracheal placement of tube but have not been systemically evaluated for pediatric practice. Aim: The study was performed to compare conventional pediatric Macintosh – with different optical laryngoscopes in difficult endotracheal intubation in infants. We hypothesized that inexperienced anesthetists would perform more successful with optical devices and that differences between the devices would be found. Methods/Materials: In this randomized controlled study, 30 anesthesia residents performed endotracheal intubation in an infant model of difficult airway presenting with airway obstruction and neck immobilization. Primary endpoints were intubation success rate and intubation time. Beyond that glottis view, dental trauma and difficulty of technique were evaluated and measured by a study observer. Macintosh, Airtraq^®, Storz DCI^®‐, and Gyrus Infant Bullard^® laryngoscopes were used in random order. After standardized briefing every resident had three attempts of at most 120 s with every device to place a 3‐mm tube into the trachea. Glottis view and difficulty of technique were rated by the residents using classification of Cormack/Lehane and Visual Analogue Scale (VAS; 0 = easy to 10 = very difficult). Results: Success rate was 41% with conventional Macintosh, 43% with Airtraq^®, 62% with Storz DCI^®, and 100% with Bullard^® laryngoscopes. Median time from passing the lips to first ventilation was 67 s (Storz DCI^® laryngoscope), 54 s (Macintosh laryngoscope), 45 s (Airtraq^® laryngoscope), and 21 s (Bullard^® laryngoscope), respectively. Dental trauma did not occur with Bullard^® laryngoscope and was frequent with Storz DCI^® laryngoscope (39%) and Macintosh laryngoscope (42%). Glottis view was best with Bullard^® laryngoscope (Grade 1 in 100%) and worst with Macintosh laryngoscope (Grade 1 in 2%). Difficulty of technique was rated with a VAS score of 2 (Bullard^® laryngoscope), 4.5 (Storz DCI^® laryngoscope) and 6 (Airtraq^®‐ and Macintosh laryngoscopes). Conclusions: Inexperienced anesthetists have higher success rates and shorter intubation times with optical‐assisted laryngoscopes compared with conventional Macintosh laryngoscope. Gyrus Infant Bullard^® laryngoscope significantly undertakes best success rate and shortest intubation time with mildest impact to maxillary dents and easiest technique. Our findings support the hypothesis that optical laryngoscopes can be used successfully by inexperienced anesthetists in simulated difficult pediatric airway conditions.     

Comparison of the CobraPLA (Cobra Perilaryngeal Airway) and the Laryngeal Mask Airway Unique in children under pressure controlled ventilation

Background: The Laryngeal Mask Airway‐Unique (LMAU) and CobraPLA^TM (Cobra Perilaryngeal Airway) are supraglottic airway devices. There are no published studies comparing these devices in children breathing with pressure controlled ventilation (PCV). Methods: Eighty pediatric patients, scheduled for elective general surgery of short duration, were randomly assigned to have either a CobraPLA^TM or a LMAU used for airway management using PCV. We compared the devices with respect to (i) ability to form an effective cuff seal, (ii) oxygenation, (iii) endtidal carbon dioxide level, (iv) time to achieve an effective airway, (v) airway interventions required for insertion, (vi) fiberoptic score, (vii) respiratory variables and (vii) adverse events. Results: Cuff seal pressure was significantly higher for CobraPLA^TM (27.08 ± 4.15 cmH₂O) than for LMAU (20.91 ± 2.47 cmH₂O). Oxygenation was similar in both groups while the mean endtidal CO₂ in the CobraPLA^TM group was significantly higher than in the LMAU group (36.47 ± 1.93 mmHg vs 34.71 ± 3.05 mmHg, P = 0.021). Time and ease of insertion were similar, with CobraPLA^TM requiring more frequent jaw lift and LMAU requiring more frequent adjustment of the head and neck to achieve a proper position. Fiberoptic scores were excellent with both devices. Respiratory variables were similar with the exception that the plateau pressure and mean peak pressures were significantly lower with CobraPLA^TM. There was a low rate of blood mucosal staining of the devices. No patient in either group reported a sore throat. Conclusions: Both devices appear to be safe and effective in establishing an adequate airway in healthy children undergoing surgery of short duration with PCV.     

A framework for the management of the pediatric airway

Critical airway incidents in children are a frequent problem in pediatric anesthesia and remain a significant cause of morbidity and mortality. Young children are at particular risk in the perioperative period. Delayed management of airway obstruction can quickly lead to serious complications due to the short apnea tolerance in children. A simple, time critical, and pediatric‐specific airway management approach combined with dedicated teaching, training, and frequent practice will help to reduce airway‐related pediatric morbidity and mortality. There is currently no pediatric‐specific universal framework available to guide practice. Current algorithms are modifications of adult approaches which are often inappropriate because of differences in age‐related anatomy, physiology, and neurodevelopment. A universal and pragmatic approach is required to achieve acceptance across diverse pediatric clinicians, societies, and groups. Such a framework will also help to establish minimum standards for pediatric airway equipment, personnel, and medications whenever pediatric airway management is required.     

Retrospective audit of the air-Q intubating laryngeal airway as a conduit for tracheal intubation in pediatric patients with a difficult airway

Objectives: To assess the efficacy of the ILA as a conduit for tracheal intubation in pediatric patients with a difficult airway. Aim: The primary goals of this retrospective audit were to assess the clinical performance of the ILA in pediatric patients with a difficult airway, expand on our initial favorable experience with this device, and collect pilot data for future prospective and comparison studies. Methods: The charts of patients with a difficult airway in whom the ILA was used during a period of 1 year in a freestanding pediatric institution were reviewed following a practice change in the authors’ institution favoring the ILA over the laryngeal mask airway as a conduit for tracheal intubation. Results: Thirty‐four pediatric patients had an ILA placed during the course of their airway management. Eight of the 34 patients in this cohort required emergent airway management. The median age was 47.1 (0.3–202.2) months and the median weight was 16.3 (3.9–86.0) kilograms. Three of the cases were unanticipated difficult airways and the remaining were anticipated difficult airways as a result of craniofacial syndromes (n = 21), cervical spine instability or immobility (n = 7), or airway hemorrhage (n = 3). Thirty‐three of the 34 patients (97%) were intubated on the first attempt through the ILA, with the aid of a fiberoptic bronchoscope (n = 25), a Shikani Optical Stylet (n = 7), or blindly (n = 2). In one patient, blind tracheal intubation required a second attempt for successful intubation, making the overall success rate 100%. Oxygen desaturation was noted in 6 of the 34 cases. Conclusions: In a series of pediatric patients with difficult airways, the ILA was successfully used as a conduit for tracheal intubation in all patients. Visualization techniques may offer a greater degree of success in intubations through the ILA due to the potential for epiglottic down‐folding in children.     

A comparison of bonfils fiberscope‐assisted laryngoscopy and standard direct laryngoscopy in simulated difficult pediatric intubation: a manikin study

Introduction: Difficult airway management in children is challenging. One alternative device to the gold standard of direct laryngoscopy is the STORZ Bonfils fiberscope (Karl Storz Endoscopy, Tuttlingen, Germany), a rigid fiberoptic stylette‐like scope with a curved tip. Although results in adults have been encouraging, reports regarding its use in children have been conflicting. We compared the effectiveness of a standard laryngoscope to the Bonfils fiberscope in a simulated difficult infant airway. Methods: Ten pediatric anesthesiologists were recruited for this study and asked to perform three sets of tasks. For the first task, each participant intubated an unaltered manikin (SimBaby ^TM, Laerdal, Puchheim, Germany) five times using a styletted 3.5 endotracheal tube (ETT) and a Miller 1 blade (group DL‐Normal). For the second task, a difficult airway configuration simulating a Cormack‐Lehane grade 3B view was created by fixing a Miller‐1 blade into position in the manikin using a laboratory stand. Each participant then intubated the manikin five times with a styletted 3.5 ETT using conventional technique but without touching the laryngoscope (group DL‐Difficult). In the third task, the manikin was kept in the same difficult airway configuration, and each participant intubated the manikin five times using a 3.5‐mm ETT mounted on the Bonfils fiberscope as an adjunct to direct laryngoscopy with the Miller‐1 blade (group BF‐Difficult). Primary outcomes were time to intubate and success rate. Results: A total of 150 intubations were performed. Correct ETT placement was achieved in 100% of attempts in group DL‐Normal, 90% of attempts in group DL‐Difficult and 98% of attempts in BF‐Difficult. Time to intubate averaged 14 s (interquartile range 12–16) in group DL‐Normal; 12 s (10–15) in group DL‐Difficult; and 11 s (10–18) in group BF‐Difficult. The percentage of glottic opening seen (POGO score) was 70% (70–80) in group DL‐Normal; 0% (0–0) in group DL‐Difficult; and 100% (100–100) in group BF‐Difficult. Discussion: The Bonfils fiberscope‐assisted laryngoscopy was easier to use and provided a better view of the larynx than simple direct laryngoscopy in the simulated difficult pediatric airway, but intubation success rate and time to intubate were not improved. Further studies of the Bonfils fibrescope as a pediatric airway adjunct are needed.     

Anestesia para cesárea em gestante com síndrome de Cockayne: relato de caso

Cockayne syndrome is an autosomal recessive multi‐systemic disorder due to DNA repair failure. It was originally described in 1936 in children of small stature, retinal atrophy and deafness, characterized by dwarfism, cachexia, photosensitivity, premature aging and neurologic deficits. The most typical feature is described as birdlike facies: protruding maxilla, facial lipoatrophy, sunken eyes, large ears and thin nose. Difficult airway management with subglottic stenosis and risk of gastric content aspiration has been described. Although the clinical characteristics of Cockayne syndrome have been well described in pediatric publications, there is only one report in the literature on anesthesia for an obstetric patient. We report the case of a pregnant patient diagnosed with Cockayne syndrome, submitted successfully to spinal anesthesia for a cesarean section due to cephalopelvic disproportion. In view of the difficult decision between inducing general anesthesia in a patient with a likely difficult airway, or neuraxial anesthesia in a patient with cardiovascular, respiratory and neurocognitive limitations, we suggest tailored management to reach the best results for the mother and newborn.     

The normal and the challenging pediatric airway

Management of a child’s airway is one of the main sources of stress for anesthetists who do not routinely anesthetize children. Unfortunately, trainees are gaining less experience in pediatric airway management than in the past, which is particularly difficult at a time when some beliefs about airway management are being challenged and airway management is less standardized. Fortunately, most children have an easily managed, normal airway. Nevertheless, it is of vital importance to teach our trainees the basic airway skills that are probably the most important skill in an anesthetists’ repertoire when it comes to a difficult airway situation. This review focuses on the airway management in children with a normal and a challenging airway. Different choices of airway management in children, and their advantages and disadvantages are discussed. Furthermore, the three broad causes of a challenging airway in children and infants are highlighted – the difficulty obtaining a mask seal, difficulty visualizing the vocal cords, and the third cause in which the larynx can be visualized but the difficulty lies at or beyond that level. Guidelines are given how to deal with these patients as well as with the feared but rare scenario of ‘cannot ventilate, cannot intubate’ in children.     

Reduced air leakage by adjusting the cuff pressure in pediatric laryngeal mask airways during spontaneous ventilation

Background: Optimal inflation of the laryngeal mask airway (LMA) cuff should allow ventilation with low leakage volumes and minimal airway morbidity. Manufacturer’s recommendations vary, and clinical end‐points have been shown to be associated with cuff hyperinflation and increased leak around the LMA. However, measurement of the intra‐cuff pressure of the LMA is not routine in most pediatric institutions, and the optimal intra‐cuff pressure in the LMA has not been determined in clinical studies. Methods: This was a prospective audit in100 pediatric patients undergoing elective general anesthesia breathing spontaneously via LMA (size 1.5–3). Cuff pressure within the LMA was adjusted using a calibrated pressure gauge to three different values (60, 40, and 20 cmH₂O) within the manufacturers’ recommended LMA cuff pressure range (≤60 cmH₂O). Three corresponding inspiratory and expiratory tidal volumes were recorded, and the differences were calculated as the ‘leak volume’. Results: Compared with 20 and 60 cmH₂O intra‐cuff pressure, measured leakage volumes were the lowest at cuff inflation pressures of 40 cmH₂O [median (range) 0.42 (0.09–1.00) ml·kg^?1] in most patients (83%), while 17% of children demonstrated minimally smaller leakages at 20 cmH₂O [0.51 (0.11–1.79) ml·kg^?1]. Maximum leakage values occurred with cuff pressures of 60 cmH₂O in all groups [0.65 (0.18–1.27) ml·kg^?1] and were not associated with the smallest value of air leakage in any patient. Conclusion: Using cuff manometry, an intra‐cuff pressure of 40 cmH₂O was associated with reduced leak around the LMA while higher (60 cmH₂O) and lower (20 cmH₂O) cuff pressures resulted in higher leak volumes during spontaneous ventilation. In spontaneously breathing children, reducing the intra‐cuff pressure of pediatric‐sized LMAs even below the manufacturers’ recommendations allows ventilation with minimized leakage around the LMA cuff.     

Pediatric airway management education and training

Education in medicine, informed by research findings, is moving away from the traditional apprenticeship model and increasingly embraces new, active learning methodologies. In this article, we will review these methodologies along with adult learning theories; we explore the available evidence on acquisition and maintenance of pediatric airway management skills, including technical and nontechnical skills. We recall the elements of a competency‐based curriculum and how they can be applied in pediatric airway skill training and suggest mapping strategies based on research evidence. We propose future directions in education and educational research in the field.     

Management of the difficult and failed airway in obstetric anesthesia

Difficulty with airway management in obstetric patients occurs infrequently and failure to secure an airway is rare. A failed airway may result in severe physical and emotional morbidity and possibly death to the mother and baby. Additionally, the family, along with the medical and nursing staff, may face emotional and financial trauma. With the increase in the number of cesarean sections performed under regional anesthesia, the experience and training in performing endotracheal intubations in obstetric anesthesia has decreased. This article reviews the management of the difficult and failed airway in obstetric anesthesia. Underpinning this important topic is the difference between the nonpregnant and pregnant state. Obstetric anatomy and physiology, endotracheal intubation in the obstetric patient, and modifications to the difficult airway algorithms required for obstetric patients will be discussed. We emphasize that decisions regarding airway management must consider the urgency of delivery of the baby. Finally, the need for specific equipment in the obstetric difficult and failed airway is discussed. Worldwide maternal mortality reflects the health of a nation. However, one could also claim that, particularly in Western countries, maternal mortality may reflect the health of the specialty of anesthesia.     

Comparison of the Cobalt Glidescope® video laryngoscope with conventional laryngoscopy in simulated normal and difficult infant airways*

Aim: To evaluate the new pediatric Glidescope^® (Cobalt GVL^® Stat) by assessing the time taken to tracheal intubation under normal and difficult intubation conditions. We hypothesized that the Glidescope^® would perform as well as conventional laryngoscopy. Background: A new pediatric Glidescope^® became available in October 2008. It combines a disposable, sterile laryngoscope blade and a reusable video baton. It is narrower and longer than the previous version and is available in a greater range of sizes more appropriate to pediatric use. Methods: We performed a randomized study of 32 pediatric anesthetists and intensivists to compare the Cobalt GVL^® Stat with the Miller laryngoscope under simulated normal and difficult airway conditions in a pediatric manikin. Results: We found no difference in time taken to tracheal intubation using the Glidescope^® or Miller laryngoscope under normal (29.3 vs 26.2 s, P = 0.36) or difficult (45.8 and 44.4 s, P = 0.84) conditions. Subjective evaluation of devices for field of view (excellent: 59% vs 53%) and ease of use (excellent: 69% vs 63%) was similar for the Miller laryngoscope and Glidescope^®, respectively. However, only 34% of participants said that they would definitely use the Glidescope^® in an emergency compared with 66% who would be willing to use the Miller laryngoscope. Conclusions: The new Glidescope^® performs as well as the Miller laryngoscope under simulated normal and difficult airway conditions.     

Experience With the Levitronix CentriMag in the Pediatric Population as a Bridge to Decision and Recovery

Short‐term mechanical circulatory support in the pediatric population with acute cardiac failure has traditionally been limited to extracorporeal membrane oxygenation given the limited availability of pediatric‐sized pumps. The Levitronix CentriMag system (Thoratec Corporation, Pleasanton, CA, USA) offers expanded options for short‐term support for this population. We report our experience with the successful use of the CentriMag in the pediatric population as a bridge to decision after postcardiotomy ventricular failure and as a bridge to recovery after heart transplantation. The first patient was bridged to a long‐term HeartMate II (Thoratec Corporation) as a bridge to potential recovery. The second patient was supported after severe graft failure post heart transplantation, with a full recovery. The Levitronix CentriMag has proven to be a versatile, safe, and effective short‐term circulatory support system for our pediatric patients.