Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2023.12.002
Brazilian Journal of Anesthesiology
Original investigation

Recommendations from the Brazilian Society of Anesthesiology (SBA) for difficult airway management in pediatric care

Recomendações da Sociedade Brasileira de Anestesiologia (SBA) para manejo da via aérea difícil em pediatria

Luciana Cavalcanti Lima, Débora de Oliveira Cumino, Alex Madeira Vieira, Cláudia Helena Ribeiro da Silva, Mariana Fontes Lima Neville, Felipe Oliveira Marques, Vinicius Caldeira Quintão, Ricardo Vieira Carlos, Ana Carla Giosa Fujita, Hugo Ítalo Melo Barros, Daniela Biachi Garcia, Cynthia Beatriz Tostes Ferreira, Guilherme Antonio Moreira de Barros, Norma Sueli Pinheiro Módolo

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Abstract

Difficult airway management in pediatrics during anesthesia represents a major challenge, requiring a careful approach, advanced technical expertise, and accurate protocols. The task force of the Brazilian Society of Anesthesiology (SBA) presents a report containing updated recommendations for the management of difficult airways in children and neonates. These recommendations have been developed based on the consensus of a panel of experts, with the objective of offering strategies to overcome challenges during airway management in pediatric patients. Grounded in evidence published in international guidelines and expert opinions, the report highlights crucial steps for the appropriate management of difficult airways in pediatrics, encompassing assessment, preparation, positioning, pre-oxygenation, minimizing trauma, and, paramountly, the maintenance of arterial oxygenation. The report also delves into additional strategies involving the use of advanced tools, such as video laryngoscopy, flexible intubating bronchoscopy, and supraglottic devices. Emphasis is placed on the simplicity of implementing the outlined recommendations, with a focus on the significance of continuous education, training through realistic simulations, and familiarity with the latest available technologies. These practices are deemed essential to ensure procedural safety and contribute to the enhancement of anesthesia outcomes in pediatrics.

Keywords

Airway management Difficult airway Intubation Laryngoscopy Neonate Pediatric anesthesia Consensus

Resumo

Resumo
O controle da via aérea difícil em anestesia pediátrica é um desafio de grande relevância, demandando uma abordagem meticulosa, conhecimentos técnicos avançados e a aplicação de protocolos precisos. Uma força-tarefa da Sociedade Brasileira de Anestesiologia (SBA) apresenta um relatório com recomendações atualizadas para o controle da via aérea difícil em crianças e neonatos. Estas recomendações resultam do consenso de um grupo de anestesiologistas, visando fornecer estratégias para superar desafios durante o controle da via aérea em pacientes pediátricos. As orientações têm sua base em evidências publicadas em diretrizes internacionais e em opiniões de especialistas. O documento destaca etapas essenciais para o controle adequado da via aérea difícil em pediatria, abrangendo avaliação, preparação, posicionamento, pré-oxigenação, minimização de traumas e, sobretudo, a manutenção prioritária da oxigenação. Adicionalmente, são apresentadas e discutidas recomendações para o uso de recursos avançados, como videolaringoscopia, fibrobroncoscopia e dispositivos supraglóticos. Tais diretrizes foram delineadas de forma a serem simples e de fácil implementação. Neste contexto, enfatizamos a importância da formação contínua, do treinamento em simulações realísticas e da familiaridade com as tecnologias disponíveis. Estas práticas são essenciais para garantir a segurança dos procedimentos e contribuir para resultados clínicos aprimorados em anestesia pediátrica.

Palavras-chave

Controle da via aérea; Via aérea difícil; Intubação; Laringoscopia; Neonato; Anestesia pediátrica; Consenso

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