Hostname: page-component-78c5997874-v9fdk Total loading time: 0 Render date: 2024-11-13T01:13:52.466Z Has data issue: false hasContentIssue false

IMMEDIATE POST-NATAL AIRWAY MANAGEMENT WHERE THERE ARE ANTENATAL CONCERNS

Published online by Cambridge University Press:  03 May 2016

NEIL TAN
Affiliation:
Department of Otolaryngology, Addenbrooke's Hospital, Cambridge, United Kingdom
NICO JONAS*
Affiliation:
Department of Otolaryngology, Addenbrooke's Hospital, Cambridge, United Kingdom
*
Nico Jonas, Department of Otolaryngology, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, United Kingdom. Email: [email protected]

Extract

Management of the antenatal compromised airway is a situation that can at best be controlled and managed in a way that is safe for both mother and baby. As the 16th century author, Miguel de Cervantes wrote “Forewarned, forearmed; to be prepared is half the victory”, in a similar fashion we, as clinicians involved in the management of neonatal airways must recognise and prepare for all eventualities in order to produce the best outcomes for our patients. In this review, we discuss strategies in managing the compromised neonatal airway along with specific pathologies that may cause post-natal airway compromise. With each sub-group of pathologies, we suggest potential strategies that can be considered in their management.

Type
Review Article
Copyright
Copyright © Cambridge University Press 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Resuscitation Council UK. Newborn Life Support, 2010.Google Scholar
2. Kattwinkel, J, Perlman, JM, Aziz, K, Colby, C, Fairchild, K, Gallagher, J, et al. Neonatal resuscitation: 2010 American heart association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Pediatrics 2010; 126 (5): e1400–13.Google Scholar
3. Jagannathan, N, Ramsey, MA, White, MC, Sohn, L. An update on newer pediatric supraglottic airways with recommendations for clinical use. Paediatr Anaesth 2015; 25: 334–45.Google Scholar
4. Brain, AI. The laryngeal mask–a new concept in airway management. Br J Anaesth 1983; 55 (8): 801–5.CrossRefGoogle ScholarPubMed
5. Paterson, SJ, Byrne, PJ, Molesky, MG, Seal, RF, Finucane, BT. Neonatal resuscitation using the laryngeal mask airway. Anesthesiology 1994; 80 (6): 1248–53; discussion 1227A.CrossRefGoogle ScholarPubMed
6. Brimacombe, J, Gandini, D. “Airway rescue and drug delivery in an 800 g neonate with the laryngeal mask airway. Paediatr Anaesth 1999; 9 (2): 178.Google Scholar
7. Trevisanuto, D, Ferrarese, P, Zanardo, V, Chiandetti, L. Laryngeal mask airway in neonatal resuscitation: a survey of current practice and perceived role by anaesthesiologists and paediatricians. Resuscitation 2004; 60 (3): 291–6.Google Scholar
8. Gandini, D, Brimacombe, JR. Neonatal resuscitation with the laryngeal mask airway in normal and low birth weight infants. Anesth Analg 1999; 89 (3): 642–3.Google Scholar
9. Singh, R, Mohan, C, Taxak, S. Controlled trial to evaluate the use of LMA for neonatal resuscitation. J Anaesthesiol Clin Pharmacol 2005; 21: 303.Google Scholar
10. Feroze, F, Khuwaja, A, Masood, N, Malik, FL. Neonatal resuscitation: the use of laryngeal mask airway. Professional Med J 2008; 15: 148–52.CrossRefGoogle Scholar
11. Zanardo, V, Weiner, G, Micaglio, M, Doglioni, N, Buzzacchero, R, Trevisanuto, D. Delivery room resuscitation of near-term infants: role of the laryngeal mask airway. Resuscitation 2010; 81 (3): 327–30.CrossRefGoogle ScholarPubMed
12. Micaglio, M, Doglioni, N, Parotto, M, Zanardo, V, Ori, C, Trevisanuto, D. Training for neonatal resuscitation with the laryngeal mask airway: a comparison of the LMA-ProSeal and the LMA-Classic in an airway management manikin. Paediatr Anaesth 2006; 16 (10): 1028–31.CrossRefGoogle Scholar
13. Trevisanuto, D, Parotto, M, Doglioni, N, Ori, C, Zanardo, V, Micaglio, M. The supreme laryngeal mask airway (LMA): a new neonatal supraglottic device: comparison with classic and ProSeal LMA in a manikin. Resuscitation 2012; 83 (1): 97100.Google Scholar
14. Atherton, DP, O'Sullivan, E, Lowe, D, Charters, P. A ventilation-exchange bougie for fibreoptic intubations with the laryngeal mask airway. Anaesthesia 1996; 51 (12): 1123–26.CrossRefGoogle ScholarPubMed
15. Association of paediatric anaesthetists of Great Britain and Ireland. APAGBI Paediatric Airway Guidelines 2013.Google Scholar
16. Ellis, DS, Potluri, PK, O'Flaherty, JE, Baum, VC. Difficult airway management in the neonate: a simple method of intubating through a laryngeal mask airway. Paediatr Anaesth 1999; 9 (5): 460–2.Google Scholar
17. Cain, JM, Mason, LJ, Martin, RD. Airway management in two of newborns with pierre robin sequence: the use of disposable vs multiple use LMA for fiberoptic intubation. Paediatr Anaesth 2006; 16 (12): 1274–6.Google Scholar
18. Sinha, R, Chandralekha, , Ray, BR. Evaluation of air-Q intubating laryngeal airway as a conduit for tracheal intubation in infants–a pilot study. Paediatr Anaesth 2012; 22 (2): 156–60.Google Scholar
19. Mychaliska, GB, Bealer, JF, Graf, JL, Rosen, MA, Adzick, NS, Harrison, MR. Operating on placental support: the ex utero intrapartum treatment procedure. J Pediatr Surg 1997; 32 (2): 227–30; discussion 230–221.CrossRefGoogle ScholarPubMed
20. Kelly, MF, Berenholz, L, Rizzo, KA, Greco, R, Wolfson, P, Zwillenberg, DA. Approach for oxygenation of the newborn with airway obstruction due to a cervical mass. Ann Otol Rhinol Laryngol 1990; 99 (3 Pt 1): 179–82.Google Scholar
21. Tanaka, M, Sato, S, Naito, H, Nakayama, H. Anaesthetic management of a neonate with prenatally diagnosed cervical tumour and upper airway obstruction. Can J Anaesth 1994; 41 (3): 236–40.Google Scholar
22. Laje, P, Peranteau, WH, Hedrick, HL, Flake, AW, Johnson, MP, Moldenhauer, JS, et al. Ex utero intrapartum treatment (EXIT) in the management of cervical lymphatic malformation. J Pediatr Surg 2015; 50 (2): 311–4.CrossRefGoogle ScholarPubMed
23. Gonik, NJ, Cheng, J, Lesser, M, Shikowitz, MJ, Smith, LP. Patient selection in congenital pyriform aperture stenosis repair – 14 year experience and systematic review of literature. Int J Pediatr Otorhinolaryngol (2015); 79 (2): 235–9.Google Scholar
24. Brown, OE, Myer, CM, Manning, SC. Congenital nasal pyriform aperture stenosis. Laryngoscope 1989; 99 (1): 8691.Google Scholar
25. Van Den Abbeele, T, Triglia, JM, François, M, Narcy, P. Congenital nasal pyriform aperture stenosis: diagnosis and management of 20 cases. Ann Otol Rhinol Laryngol 2001; 110 (1): 7075.Google Scholar
26. Devambez, M, Delattre, A, Fayoux, P. Congenital nasal pyriform aperture stenosis: diagnosis and management. Cleft Palate Craniofac J 2009; 46 (3): 262–7.Google Scholar
27. Losken, A, Burstein, FD, Williams, JK. Congenital nasal pyriform aperture stenosis: diagnosis and treatment. Plast Reconstr Surg 2002; 109 (5): 1506–11Google Scholar
28. Tate, JR, Sykes, J. Congenital nasal pyriform aperture stenosis. Otolaryngol Clin North Am 2009; 42 (3): 521–5.CrossRefGoogle ScholarPubMed
29. Hoving, EW. Nasal encephaloceles. Childs Nerv Syst 2000; 16 (10–11): 702–6.CrossRefGoogle ScholarPubMed
30. Hughes, GB, Sharpino, G, Hunt, W, Tucker, HM. Management of the congenital midline nasal mass: a review. Head Neck Surg 1980; 2 (3): 222–33Google Scholar
31. Narasimhan, K, Coticchia, J. Transsphenoidal encephalocele in a neonate. Ear Nose Throat J 2006; 85 (3–4): 420, 422.Google Scholar
32. Kalkan, G, Paksu, S, Asilioglu, N, Kiliç, M. Nasopharyngeal encephalocele: a rare cause of upper airway obstruction. Hong Kong Med J 2013; 19 (2): 186–7.Google ScholarPubMed
33. Menasse-Palmer, , L, Bogdanow, A, Marion, RW. Choanal Atresia. Paediatrics in Review 1995; 16: 475–6.CrossRefGoogle ScholarPubMed
34. Dimitrov, B, Balikova, I, Jekova, N, Vakrilova, L, Fryns, JP, Simeonov, E. Acrofacial dysostosis type Rodriguez. Am J Med Genet A (2005); 135 (1): 8185.CrossRefGoogle ScholarPubMed
35. Bianchi, DW. Fetology: diagnosis and management of the fetal patient. New York: McGraw-Hill Medical Pub. Division 2010; 214–21.Google Scholar
36. Vettraino, IM, Lee, W, Bronsteen, RA, Harper, CE, Aughton, D, Comstock, CH. Clinical outcome of fetuses with sonographic diagnosis of isolated micrognathia. Obstet Gynecol 2003; 102 (4): 801–5.Google Scholar
37. Paladini, D. Fetal micrognathia: almost always an ominous finding. Ultrasound Obstet Gynecol 2010; 35 (4): 377–84.Google Scholar
38. Christison-Lagay, ER, Fishman, SJ. Vascular anomalies. Surg Clin North Am 2006; 86 (2): 393425.CrossRefGoogle ScholarPubMed
39. Langer, JC, Fitzgerald, PG, Desa, D, Filly, RA, Golbus, MS, Adzick, NS, et al. Cervical cystic hygroma in the fetus: clinical spectrum and outcome. J Pediatr 1990; 25 (1): 5861; discussion 61–2.Google Scholar
40. Gedikbasi, A, Gul, A, Sargin, A, Ceylan, Y. Cystic hygroma and lymphangioma: associated findings, perinatal outcome and prognostic factors in live-born infants. Arch Gynecol Obstet 2007; 276 (5): 491–8. Epub 2007 Apr 12.Google Scholar
41. Bianchi, DW. Fetology: diagnosis and management of the fetal patient. New York: McGraw-Hill Medical Pub. Division; 2010; 231–7.Google Scholar
42. Cavoretto, P, Molina, F, Poggi, S, Davenport, M, Nicolaides, KH. Prenatal diagnosis and outcome of echogenic fetal lung lesions. Ultrasound Obstet Gynecol 2008; 32 (6): 769–83.CrossRefGoogle ScholarPubMed
43. Smith, II, Bain, AD. Congenital atresia of the larynx. A report of nine cases. Ann Otol Rhinol Laryngol 1965; 74: 338–49.Google Scholar
44. Zaw-Tun, HI. Development of congenital laryngeal atresias and clefts. Ann Otol Rhinol Laryngol (1988); 97 (4 Pt 1): 353–8.Google Scholar
45. Ryan, DP, Doody, DP. Management of congenital tracheal anomalies and laryngotracheoesophageal clefts. Semin Pediatr Surg 2014; 23 (5): 257–60.Google Scholar
46. Floyd, J, Campbell, DC, et al. Agenesis of the trachea. Am Rev Respir Dis 1962; 86: 557–60.Google Scholar
47. Coleman, AM, Merrow, AC, Dominy, DE. Tracheal agenesis with tracheoesophageal fistulae: fetal MRI diagnosis with confirmation by ultrasound during an ex utero intrapartum therapy (EXIT) delivery and postdelivery MRI. Pediatr Radiol 2013; 43 (10): 1385–90.Google Scholar
48. de Groot-van der, Mooren, Haak, MC, Lakeman, P, Cohen-Overbeek, TE, van der Voorn, JP, Bretschneider, JH, et al. Tracheal agenesis: approach towards this severe diagnosis. Case report and review of the literature. Eur J Pediatr 2012; Mar; 171 (3): 425–31.Google Scholar
49. Watanabe, T, Okuyama, H, Kubota, A, Kawahara, H, Hasegawa, T, Ueno, T, et al. A case of tracheal agenesis surviving without mechanical ventilation after external esophageal stenting. J Pediatr Surg 2008; 43 (10): 1906–8.Google Scholar
50. Jacobs, JP, Elliott, MJ, Haw, MP, Bailey, CM, Herberhold, C. Pediatric tracheal homograft reconstruction: a novel approach to complex tracheal stenoses in children. J Thorac Cardiovasc Surg 1996; 112 (6): 15491558; discussion 1559–1560.CrossRefGoogle ScholarPubMed
51. Cantrell, JR, Guild, HG. Congenital stenosis of the trachea. Am J Surg 1964; 108: 297305.Google Scholar
52. Loeff, DS, Filler, RM, Vinograd, I, Ein, SH, Williams, WG, Smith, CR, et al. Congenital tracheal stenosis: a review of 22 patients from 1965 to 1987. J Pediatr Surg 23 (8): 744748.Google Scholar