Department of Anesthesiology, Bilim University School of Medicine Istanbul, Turkey
Received: 17 November, 2014; Accepted: 21 November, 2014; Published: 24 November, 2014
Dr. Ayten Saracoglu Bilim University Medical School, Florence Nightingale Hospital Abide-I Hurriyet Cad, No:166 Sisli, Istanbul, Turkey, Tel: +902123756565; Email:
Saracoglu A (2014) "Cannot ventilate cannot Intubate" Newborns. Glob J Anesthesiol 1(1): 028-028. DOI: 10.17352/2455-3476.000005
© 2014 Saracoglu A. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Difficult airway is defined as the clinical situation in which a trained anesthesiologist experiences difficulty with mask ventilation, difficulty with tracheal intubation, or both . There is very little data on failed intubation in newborns and infants . Surgical cricothyroidotomy is not recommended in pediatric patients due to the small size of the cricothyroid membrane . Although surgical cricothyroidotomy is an option, it is a difficult procedure to perform in young children, infants and newborns. Transtracheal or transcricothyroid needle approach may be the only option for young children, infants and newborns that cannot be intubated and ventilated .
Barotrauma due to increased intrathoracic pressure or depression of hemodynamic data may lead to a noisier clinical picture in pediatric patients . Manual jet ventilation is recommended for adults; however, there is very limited information on application of percutaneous transtracheal jet ventilation in infants or newborns . Ventrain is a device, which can be used manually and allows oxygen insufflation with small lumen ventilation. It transforms oxygen flow coming from a high-pressure source into a manageable flow . Manujet III is a portable device, which can be easily adjusted for manual jet ventilation. It enables ventilation of patients through a low mechanical dead-space volume . However, its use in pediatric patients has not been approved, yet. Another practical method is to achieve ventilation by getting an intravenous cannula through the cricothyroid membrane. However, this method may be risky at times.
The use of emergency percutaneous techniques in pediatric patients is a controversial issue. The technical issues including identification of cricothyroid membrane and placement of transtracheal ventilation needle catheter are the major challenges of these techniques.
In any event, ventilation of the newborn must be realized with an appropriate technique within the period till the achievement of emergency tracheostomy, provision of successful intubation, or wakening of the newborn. Every anesthesiologist should be well-informed of and familiar with at least one technique for ensuring transtracheal oxygenation in emergencies. It is also important to have the required equipments in the working area ready to be used in emergencies.
- (2003) American Society of Anesthesiologists Task Force on Difficult Airway Management. 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. Anesthesiology 98: 1269-1277.
- Cote CJ, Hartnick CJ (2009) Pediatric transtrac- heal and cricothyrotomy airway devices for emergency use: which are appropriate for infants and children? Pediatr Anesth 19: 66–76.
- Navsa N, Tossel G, Boon JM (2005) Dimensions of the neonatal cricothyroid membrane - how feasible is a surgical cricothyroidotomy? Pediatr Anesth 15: 402–406.
- Depierraz B, Ravussin P, Brossard E (1994) Percutaneous transtracheal jet ventilation for paediatric endoscopic laser treatment of laryngeal and subglottic lesions. Can J Anaesth 41: 1200–1207.
- Wong CF, Yuen VM, Wong GT, To J, Irwin MG (2014) Time to adequate oxygenation following ventilation using the Enk oxygen flow modulator versus a jet ventilator via needle cricothyrotomy in rabbits. Paediatr Anaesth 24: 208-213.
- Hamaekers AE, Borg PA, Enk D (2012) Ventrain: an ejector ventilator for emergency use. Br J Anaesth 108: 1017-1021.
- Li S, Liu Y, Tan F, Chen J, Chen L (2010) Efficacy of manual jet ventilation using Manujet III for bronchoscopic airway foreign body removal in children. Int J Pediatr Otorhinolaryngol 74: 1401-1404.
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