Background: For several decades now, the use of uncuffed endotracheal tube (ETT) is the gold standard in providing airway and ventilatory support to children under anesthesia. However, there has been a change in focus from the application of uncuffed ETT to cuffed ETT among children, and this matter has been debated for years. In fact, several studies have shown that even across and within countries, the attitudes and practices of anesthesiologists on the use of types of endotracheal tubes differed. Objective: To describe the current attitudes and practices of anesthesiologists regarding the use of uncuffed or cuffed ETT for children. Methods: A systematic review of observational studies on the current attitudes and practices of pediatric anesthesiologists regarding the use of cuffed and uncuffed ETT was conducted from May to November 2020. Cochrane reviews, Medline, Pubmed, and EMBASE were searched and yielded five relevant studies. Results: The use of cuffed ETT ranged between 11%-61% in the included studies and all reported that there were no consensus or standard on whether cuffed or uncuffed ETT was better. Reported factors for cuffed ETT use included: 1) Personal choice, 2) Department protocol, 3) Availability of resources, and 4) Specific conditions such as obesity, planned or emergency procedure, and reduced lung compliance. In terms of ETT size, reported criteria were: 1) Use of a formula, 2) Use of abacus/calculator, and 3) In relation to the fifth finger's width. Conclusions The current systematic review demonstrated that there is wide variation in current attitudes and practices of anesthesiologists regarding the use of uncuffed or cuffed endotracheal tubes in children. Likewise, factors affecting choice of ETT and criteria for selection varied in the published literature. The results of this systematic review highlight the need for a standard guideline to help clinicians choose if cuffed or uncuffed ETT is better in certain scenarios and to help them decide in selecting the most appropriate ETT size.
Anesthesiology

We describe a case of an 11 month- old boy suspected to have King- Denborough syndrome. He had multiple congenital anomalies and one of which is an inguinal hernia. Since such patients are predisposed to developing malignant hyperthermia, we did the repair of the inguinal hernia under spinal anesthesia.
Human ; Infant ; MALIGNANT HYPERTHERMIA ; HERNIA ; HERNIA, INGUINAL ; KING DENBOROUGH SYNDROME ; ANESTHESIA, SPINAL ; ANESTHESIA, CONDUCTION

Background: Propofol, a sedative agent with quick onset and short duration of action, has long been used for many adult procedures requiring anesthesia and sedation. There is hesitance, however, to its use for children because of several reports of adverse events. This hesitance reflects more of a scarcity of pediatric clinical trials rather than a proven clinical problem. This study is therefore undertaken to determine the safety of propofol infusion in normal healthy children less than three years old who will undergo elective surgeries. Methods: This was a prospective study of 24 ASA I patients under 3 years of age who underwent either lower abdominal or lower extremity surgery under combined general and regional anesthesia, and cheiloplasty/palatoplasty under general anesthesia with infraorbital block. Patients were put to sleep by sevoflurane gas induction. Endotracheal intubation was facilitated by atracurium. Blood samples for arterial blood gases (ABGs), creatinine, alanine aminotransferase (ALT) and triglycerides were extracted. After the regional block was established, sevoflurane was discontinued and the propofol infusion was started. The range of vital signs, total dose of propofol and the total time it was administered were noted. After 24 hours, ABGs, creatinine, triglycerides and ALT levels were determined. Results: Pearsons Correlation test showed that no linear relationship exist between the dose of propofol and the postoperative levels of triglycerides, creatinine and ALT. Preoperative ABG analysis showed that 29 percent had metabolic acidosis, 33 percent had respiratory acidosis and 21 percent had normal values. Postoperatively, 75 percent had normal ABG results while 25 percent had metabolic acidosis. Conclusion: Propofol is safe for use in children less than 3 years of age. No significant elevations in the postoperative levels of creatinine, ALT and triglycerides were noted in the study. Majority of patients had normal ABG results postoperatively. (Author)
Human ; Child Preschool ; PROPOFOL ; CHILD ; PROSPECTIVE STUDIES ; TRIGLYCERIDES ; CREATININE ; ANESTHESIA, CONDUCTION