Ce travail est financé par le département d&#39;anesthésiologie à l&#39;hôpital pour enfants du Michigan.

1. Préparation du matériel <ol><li> Pompe de fusion Med pour perfusion de propofol </li><li> Placer les tubes de chauffage nasotrachéale sous le matelas </li><li> Connectez la caméra à la portée et vérifier l&#39;orientation </li><li> Trois mouvements affectent la vue à travers le champ: <ol><li> In et Out. </li><li> Rotation à l&#39;aide d&#39;une manœuvre à deux mains. </li><li> Flexion et d&#39;extension de la pointe de la portée. </li></ol></li></ol> 2. Equipement complémentaire <ol><li> Fentanyl de 0,5 à 1,0 mcg / kg </li><li> 12F rouge cathéter d&#39;aspiration en caoutchouc </li><li> Glycopyrrolate 0,1-0,2 mg </li><li> Crochet en métal d&#39;insufflation </li><li> Afrin vaporisateur nasal </li><li> Lubrifiant </li><li> La lidocaïne 2% ou 4% pour la pulvérisation des narines </li></ol> 3. Préparation du patient <ol><li> Effectuer induction au masque de maintenir la ventilation spontanée. </li><li> Démarrer IV et de donner le fentanyl et le glycopyrrolate IV. </li><li> Donnez propofol Bolus 1 mg / kg et de commencer à perfusion de propofol de 200 mcg / kg / min. </li><li> Les yeux bandes avant la pulvérisation Afrin pour éviter la dilatation des pupilles. </li><li> Vaporiser Afrin et de lidocaïne dans les deux narines. </li><li> Masque ventiler le patient de distribuer et de lidocaïne Afrin distal. </li><li> Passe un cathéter en caoutchouc rouge dans les deux narines pour vérifier la perméabilité. </li><li> Choisissez la narine plusieurs brevets pour le fibroscope. </li><li> Gardez le caoutchouc rouge dans l&#39;autre narine avec la pointe dans l&#39;hypopharynx pour O 2. </li><li> Utilisez crochet de l&#39;insufflation de se connecter en caoutchouc rouge au circuit et à administrer 2 L / min d&#39;O 2 (ne pas insuffler de débits élevés dans l&#39;hypopharynx). </li></ol> 4. Réels intubation fibroscopique <ol><li> Prenez le connecteur hors du tube nasotrachéale. </li><li> Tube de l&#39;avance tout le chemin jusqu&#39;à l&#39;fibroscope lubrifié. </li><li> Nettoyer la pointe en fibre optique avec de l&#39;alcool </li><li> Mettez une légère courbe sur la fin de la portée de suivre le plancher du nez. </li><li> Enfilez la fibre optique au niveau du larynx à l&#39;aveuglette. </li><li> Recherchez les structures reconnaissables anatomique. FREEZE! </li><li> Apportez des structures anatomiques dans le centre du terrain et de les y maintenir. </li><li> Quand vous approchez les cordes vocales, donne un bolus de propofol à 1 mg / kg IV. </li><li> Une fois dans les cordes, faire un tour vers le bas dans la trachée. </li><li> Suivez anneaux de la trachée au niveau de la carène. </li><li> Vous pouvez avoir besoin d&#39;un bolus supplémentaire de propofol de 1 mg / kg IV. </li><li> Assurez-vous que la pointe fibroscope est dans une position neutre. </li><li> Enfiler le ETT. Si l&#39;ETT se raccrocher au niveau du larynx, donner un tour à 360 ° du tube pour la faire tourner dans la trachée. </li></ol> 5. Les résultats représentatifs Cette vidéo montre une technique efficace pour l&#39;intubation fibroscopique élective chez les patients pédiatriques qui est facilement enseignable aux résidents et aux boursiers et reproductibles. La clé principale est de maintenir la ventilation spontanée en tout temps. Bonne préparation du matériel avant la main est également importante.

<ol>
	<li>Kinouchi, K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Management+of+difficult+pediatric+airway.">Management of difficult pediatric airway.</a> Masui. 55, 24-32 (2006).</li><li>Chen, Y. L., Wu, K. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Airway+management+of+patients+with+craniofacial+abnormalities:+10-year+experience+at+a+teaching+hospital+in+Taiwan.">Airway management of patients with craniofacial abnormalities: 10-year experience at a teaching hospital in Taiwan.</a> J Chin Med Assoc. 72, 468-470 (2009).</li><li>. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Practice+guidelines+for+management+of+the+difficult+airway:+an+updated+report+by+the+American+Society+of+Anesthesiologists+Task+Force+on+Management+of+the+Difficult+Airway.">Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway.</a> Anesthesiology. 98, 1269-1277 (2003).</li><li>Fiadjoe, J., Stricker, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pediatric+difficult+airway+management:+current+devices+and+techniques.">Pediatric difficult airway management: current devices and techniques.</a> Anesthesiol Clin. 27, 185-195 (2009).</li><li>Wheeler, M., Roth, A. G., Dsida, R. M., Rae, B., Seshadri, R., Sullivan, C. L., Heffner, C. L., Cote, C. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Teaching+residents+pediatric+fiberoptic+intubation+of+the+trachea:+traditional+fiberscope+with+an+eyepiece+versus+a+video-assisted+technique+using+a+fiberscope+with+an+integrated+camera.">Teaching residents pediatric fiberoptic intubation of the trachea: traditional fiberscope with an eyepiece versus a video-assisted technique using a fiberscope with an integrated camera.</a> Anesthesiology. 101, 842-846 (2004).</li><li>Roth, A. G., Wheeler, M., Stevenson, G. W., Hall, S. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparison+of+a+rigid+laryngoscope+with+the+ultrathin+fibreoptic+laryngoscope+for+tracheal+intubation+in+infants.">Comparison of a rigid laryngoscope with the ultrathin fibreoptic laryngoscope for tracheal intubation in infants.</a> Can J Anaesth. 41, 1069-1073 (1994).</li><li>Ovassapian, A., Dykes, M. H., Golmon, M. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+training+programme+for+fibreoptic+nasotracheal+intubation.+Use+of+model+and+live+patients.">A training programme for fibreoptic nasotracheal intubation. Use of model and live patients.</a> Anaesthesia. 38, 795-798 (1983).</li><li>Stevenson, G. W., Roth, A. G., Wheeler, M., Hall, S. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Use+of+the+Olympus+LF-P+fibreoptic+laryngoscope+by+trainees+in+paediatric+anaesthesia.">Use of the Olympus LF-P fibreoptic laryngoscope by trainees in paediatric anaesthesia.</a> Anaesthesia. 51, (1996).</li><li>Taguchi, S., Kusunoki, S., Fukuda, H., Hamada, H., Kawamoto, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Difficult+tracheal+intubation+using+airway+scope+in+a+pediatric+patient+with+Hunter+syndrome.">Difficult tracheal intubation using airway scope in a pediatric patient with Hunter syndrome.</a> Masui. 58, 1278-1281 (2009).</li></ol>

Intubation fibroscopique chez les patients pédiatriques atteints d&#39;intubation difficile peut être une tâche ardue 1,2 et la présence de dysmorphies craniofaciales présente des défis supplémentaires pour l&#39;intubation trachéale 3. Il est plus difficile à effectuer cette procédure chez les enfants que chez les adultes en raison principalement de petites voies aériennes chez les patients pédiatriques qui font la manipulation de la fibre optique plus difficile car tout petit mouvemen...

<ul><li> Pompe de fusion Med pour perfusion de propofol </li><li> Fentanyl de 0,5 à 1,0 mcg / kg </li><li> 12F rouge cathéter d&#39;aspiration en caoutchouc </li><li> Glycopyrrolate 0,1-0,2 mg </li><li> Crochet en métal d&#39;insufflation </li><li> Afrin vaporisateur nasal </li><li> Lubrifiant </li><li> La lidocaïne 2% ou 4% pour la pulvérisation des narines </li></ul>

guidelines for elective pediatric fiberoptic intubation

Intubation fibroscopique chez les patients pédiatriques est souvent nécessaire en particulier dans les voies aériennes difficiles d&#39;syndromique des patients à savoir le syndrome de Pierre Robin. Les petits bébés se désaturer très rapidement si la ventilation est interrompue principalement à taux métabolique élevé. Nous décrivons les lignes directrices pour effectuer une intubation fibroscopique sûrs tout en conservant une respiration spontanée pendant toute la procédure. Étapes nécessitant l&#39;utilisation de la pompe du propofol, du fentanyl, glycopyrrolate, cathéter en caoutchouc rouge, crochet métallique insuflation, Afrin, lubrifiant et de pulvérisation de lidocaïne sont affichés.

Watch this Scientific Journal Video about Guidelines for Elective Pediatric Fiberoptic Intubation at JoVE.com

Guidelines for Elective Pediatric Fiberoptic Intubation

Nous décrivons les lignes directrices pour effectuer une intubation sûre et efficace élective fibroscopie chez les patients pédiatriques, tout en maintenant la ventilation spontanée.

Lignes directrices pour l&#39;intubation fibroscopique pédiatrique élective

Fiberoptic intubation in pediatric patients is often required especially in difficult airways of syndromic patients i.e. Pierre Robin Syndrome. Small ...

guidelines-for-elective-pediatric-fiberoptic-intubation

Research

JoVE Journal

Medicine

17.3K vues.  St. Jude Children's Research Hospital. Nous décrivons les lignes directrices pour effectuer une intubation sûre et efficace élective fibroscopie chez les patients pédiatriques, tout en maintenant la ventilation spontanée.

Vidéo: Guidelines for Elective Pediatric Fiberoptic Intubation

A Novel Rescue Technique for Difficult Intubation and Difficult Ventilation

We describe a novel non surgical technique to maintain oxygenation and ventilation in a case of difficult intubation and difficult ventilation, which works especially well with poor mask fit.
Can not intubate, can not ventilate" (CICV) is a potentially life threatening situation. In this video we present a simulation of the technique we used in a case of CICV where oxygenation and ventilation were maintained by inserting an endotracheal tube (ETT) nasally down to the level of the naso-pharynx while sealing the mouth and nares for successful positive pressure ventilation.
A 13 year old patient was taken to the operating room for incision and drainage of a neck abcess and direct laryngobronchoscopy. After preoxygenation, anesthesia was induced intravenously. Mask ventilation was found to be extremely difficult because of the swelling of the soft tissue. The face mask could not fit properly on the face due to significant facial swelling as well. A direct laryngoscopy was attempted with no visualization of the larynx. Oxygen saturation was difficult to maintain, with saturations falling to 80%. In order to oxygenate and ventilate the patient, an endotracheal tube was then inserted nasally after nasal spray with nasal decongestant and lubricant. The tube was pushed gently and blindly into the hypopharynx. The mouth and nose of the patient were sealed by hand and positive pressure ventilation was possible with 100% O2 with good oxygen saturation during that period of time. Once the patient was stable and well sedated, a rigid bronchoscope was introduced by the otolaryngologist showing extensive subglottic and epiglottic edema, and a mass effect from the abscess, contributing to the airway compromise. The airway was secured with an ETT tube by the otolaryngologist.This video will show a simulation of the technique on a patient undergoing general anesthesia for dental restorations.

We describe a technique to maintain oxygenation and ventilation using an endotracheal tube inserted nasally to the level of the naso-pharynx while sealing the mouth and nares for successful positive pressure ventilation.

Une technique de sauvetage pour les nouveaux intubation difficile et de ventilation difficile

We describe a novel non surgical technique to maintain oxygenation and ventilation in a case of difficult intubation and difficult ventilation, which ...

Recherche

Médecine

A Simple Method of Mouse Lung Intubation

A simple procedure to intubate mice for pulmonary function measurements would have several advantages in longitudinal studies with limited numbers or expensive animal. One of the reasons that this is not done more routinely is that it is relatively difficult, despite there being several published studies that describe ways to achieve it. In this paper we demonstrate a procedure that eliminates one of the major hurdles associated with this intubation, that of visualizing the trachea during the entire time of intubation. The approach uses a 0.5 mm fiberoptic light source that serves as an introducer to direct the intubation cannula into the mouse trachea. We show that it is possible to use this procedure to measure lung mechanics in individual mice over a time course of at least several weeks. The technique can be set up with relatively little expense and expertise, and it can be routinely accomplished with relatively little training. This should make it possible for any laboratory to routinely carry out this intubation, thereby allowing longitudinal studies in individual mice, thereby minimizing the number of mice needed and increasing the statistical power by using each mouse as its own control.

This paper describes a striaghforward and efficient method of intubating mice for pulmonary function measurements or pulmonary instillation, that allows the mice to recover and be studied at later times. The procedure involves an inexpensive fiberoptic light source that directly illuminates the trachea.

Une méthode simple d&#39;intubation poumon de souris

A  simple procedure to intubate mice for pulmonary function measurements would  have several advantages in longitudinal studies with limited numbers or  ...

Intubation-mediated Intratracheal (IMIT) Instillation: A Noninvasive, Lung-specific Delivery System

Respiratory disease studies typically involve the use of murine models as surrogate systems. However, there are significant physiologic differences between the murine and human respiratory systems, especially in their upper respiratory tracts (URT). In some models, these differences in the murine nasal cavity can have a significant impact on disease progression and presentation in the lower respiratory tract (LRT) when using intranasal instillation techniques, potentially limiting the usefulness of the mouse model to study these diseases. For these reasons, it would be advantageous to develop a technique to instill bacteria directly into the mouse lungs in order to study LRT disease in the absence of involvement of the URT. We have termed this lung specific delivery technique intubation-mediated intratracheal (IMIT) instillation. This noninvasive technique minimizes the potential for instillation into the bloodstream, which can occur during more invasive traditional surgical intratracheal infection approaches, and limits the possibility of incidental digestive tract delivery. IMIT is a two-step process in which mice are first intubated, with an intermediate step to ensure correct catheter placement into the trachea, followed by insertion of a blunt needle into the catheter to mediate direct delivery of bacteria into the lung. This approach facilitates a &#62;98% efficacy of delivery into the lungs with excellent distribution of reagent throughout the lung. Thus, IMIT represents a novel approach to study LRT disease and therapeutic delivery directly into the lung, improving upon the ability to use mice as surrogates to study human respiratory disease. Furthermore, the accuracy and reproducibility of this delivery system also makes it amenable to Good Laboratory Practice Standards (GLPS), as well as delivery of a wide range of reagents which require high efficiency delivery to the lung.

Intubation-mediated Intratracheal IMIT Instillation: A Noninvasive, Lung-specific Delivery System

Intubation-mediated intratracheal (IMIT) instillation of reagents is an excellent, noninvasive method for studying respiratory disease, as well as a method for instilling therapeutic reagents directly into the lung. It is a rapid and highly reproducible method which is suitable for preclinical testing.

Intubation médiation intratrachéale (GI-TI) instillation: un système de distribution non invasive, Lung-spécifique

Respiratory disease studies typically involve the use of murine models as surrogate systems. However, there are significant physiologic differences ...

An Improved Method for Rapid Intubation of the Trachea in Mice

Despite some anatomical and physiological differences, mouse models continue to be an essential tool for studying human lung disease. Bleomycin toxicity is a commonly used model to study both acute lung injury and fibrosis, and multiple methods have been developed for administering bleomycin (and other toxic agents) into the lungs. However, many of these approaches, such as transtracheal instillation, have inherent drawbacks, including the need for strong anesthetics and survival surgery. This paper reports a quick, reproducible method of intratracheal intubation that involves mild inhaled anesthesia, visualization of the trachea, and the use of a surrogate spirometer to confirm exposure. As a proof of concept, 8-12 week old C57BL/6 mice were administered either 2.0 U/kg of bleomycin or an equivalent volume of PBS, and both damage and fibrotic endpoints were measured post-exposure. This procedure allows researchers to treat a large cohort of mice in a relatively short period with little expense and minimal post-procedure care.

This article presents a rapid and simple method for administering bleomycin directly into the mouse trachea via intubation. Key advantages of this method are that it is highly reproducible, easy to master, and does not require specialized equipment or lengthy recovery times.

Une méthode améliorée pour Rapid intubation de la trachée chez la souris

Despite some anatomical and physiological differences, mouse models continue to be an essential tool for studying human lung disease. Bleomycin toxicity ...

Protocol and Guidelines for Point-of-Care Lung Ultrasound in Diagnosing Neonatal Pulmonary Diseases Based on International Expert Consensus

Ultrasound is a safe bedside imaging tool that obviates the use of ionizing radiation diagnostic procedures. Due to its convenience, the lung ultrasound has received increasing attention from neonatal physicians. Nevertheless, clear reference standards and guideline limits are needed for accurate application of this diagnostic modality. This document aims to summarize expert opinions and to provide precise guidance to help facilitate the use of the lung ultrasound in the diagnosis of neonatal lung diseases.

Lung ultrasound is a noninvasive and valuable tool for bedside evaluation of neonatal lung diseases. However, a relative lack of reference standards, protocols and guidelines may limit its application. Here, we aim to develop a standardized neonatal lung ultrasound diagnostic protocol to be used in clinical decision-making.

Protocole et Guidelines for Point-of-Care poumon échographie dans le diagnostic des maladies pulmonaires néonatales basés sur un Consensus d’experts internationaux

Ultrasound is a safe bedside imaging tool that obviates the use of ionizing radiation diagnostic procedures. Due to its convenience, the lung ultrasound ...

Repeated Orotracheal Intubation in Mice

The literature describes several methods for mouse intubation that either require visualization of the glottis through the oral cavity or incision in the ventral neck for direct confirmation of cannula placement in the trachea. The relative difficulty or the tissue trauma induced to the subject by such procedures can be an impediment to an investigator&#8217;s ability to perform longitudinal studies. This article illustrates a technique in which physical manipulation of the mouse following the use of a depilatory to remove hair from the ventral neck permits transcutaneous visualization of the trachea for orotracheal intubation regardless of degree of skin pigmentation. This method is innocuous to the subject and easily achieved with a limited understanding of murine anatomy. This refined approach facilitates repeated intubation, which may be necessary for monitoring progression of disease or instillation of treatments. Using this method may result in a reduction of the number of animals and technical skill required to measure lung function in mouse models of respiratory disease.

The goal of this article is to describe a refined method of intubation of the laboratory mouse. The method is noninvasive and, therefore, ideal for studies that require serial monitoring of respiratory function and/or instillation of treatments into the lung.

Intubation orotracheal répétée chez les souris

The literature describes several methods for mouse intubation that either require visualization of the glottis through the oral cavity or incision in the ...

Blind Endotracheal Intubation in Neonatal Rabbits

The newborn rabbit is a useful animal model for various pathologies and procedures. Airway management of the rabbit is complex due to its anatomical characteristics, which is further complicated in the case of the newborn. Of the different methods of advanced airway management, endotracheal intubation is less aggressive than tracheostomy, and is more feasible than supraglottic management given the lack of supraglottic devices of such a small size. As direct glottis visualization is very difficult in animals this size, this blind intubation model is presented as an effective alternative, especially for experiments requiring prolonged anesthesia. Using this method, we performed blind intubations with a 90% success rate.

We describe a technique of endotracheal intubation in newborn rabbits after esophageal catheterization with a gastric tube.

Intubation enthotracheal aveugle chez les lapins néonatals

The newborn rabbit is a useful animal model for various pathologies and procedures. Airway management of the rabbit is complex due to its anatomical ...

Endotracheal Intubation Using a Flexible Intubation Endoscope as a Standardized Model for Safe Airway Management in Swine

Endotracheal intubation is often a basic requirement for translational research in porcine models for various interventions that require a secured airway or high ventilation pressures. Endotracheal intubation is a challenging skill,&#160;requiring a minimum number of successful endotracheal intubations to achieve a high success rate under optimal conditions, which is often unachievable for non-anaesthesiology researchers. Due to the specific porcine airway anatomy, a difficult airway can usually be assumed. The impossibility of establishing a secure airway can result in injury, adverse events, or death of the laboratory animal. Using a prospective, randomized, controlled evaluation approach, it has been shown that fiberoptic-assisted endotracheal intubation takes longer but has a higher first-pass success rate than conventional intubation without causing clinically relevant drops in oxygen saturation. This model presents a standardized regimen for endoscopically guided endotracheal intubation, providing a secured airway, especially for researchers who are inexperienced in the technique of endotracheal intubation via direct laryngoscopy. This procedure is expected to minimize animal suffering and unnecessary animal losses.

The use of pigs in research has increased in recent years. Nevertheless, pigs are characterized by difficult airway anatomy. By demonstrating how to perform endoscopically guided endotracheal intubation, the present protocol aims to further increase laboratory animals' safety to avoid animal suffering and unnecessary death.

Intubation endotrachéale utilisant un endoscope d’intubation flexible comme modèle normalisé pour la gestion sécuritaire des voies respiratoires chez les porcs

Endotracheal intubation is often a basic requirement for translational research in porcine models for various interventions that require a secured airway ...

Réanimation cardio-pulmonaire extracorporelle dans un modèle animal après un arrêt cardiaque

Pediatric Animal Model of Extracorporeal Cardiopulmonary Resuscitation After Prolonged Circulatory Arrest

Congenital heart disease (CHD) is the most prevalent congenital malformation, with about one million births impacted worldwide per year. Comprehensive investigation of this disease requires appropriate and validated animal models. Piglets are commonly used for translational research due to their analogous anatomy and physiology. This work aimed to describe and validate a neonatal piglet model of cardiopulmonary bypass (CPB) with circulatory and cardiac arrest (CA) as a tool for studying severe brain damage and other complications of cardiac surgery. In addition to including a list of materials, this work provides a roadmap for other investigators to plan and execute this protocol. After experienced practitioners performed several trials, the representative results of the model demonstrated a 92% success rate, with failures attributed to small piglet size and variant vessel anatomy. Furthermore, the model allowed practitioners to select from a wide variety of experimental conditions, including varying times in CA, temperature alterations, and pharmacologic interventions. In summary, this method uses materials readily available in most hospital settings, is reliable and reproducible, and can be widely employed to enhance translational research in children undergoing heart surgery.

Pleins feux sur l’auteur : Simulation de la chirurgie cardiaque pédiatrique à l’aide d’un modèle de porcelet néonatal

This protocol describes a neonatal porcine model of cardiopulmonary bypass (CPB), with circulatory and cardiac arrest as a tool for studying severe brain damage and other complications secondary to CPB.

Modèle animal pédiatrique de réanimation cardiorespiratoire extracorporelle après arrêt circulatoire prolongé

Congenital heart disease (CHD) is the most prevalent congenital malformation, with about one million births impacted worldwide per year. Comprehensive ...

Methods Article

Lignes directrices pour l'intubation fibroscopique pédiatrique élective