The first African presentation of the PEMC (Pediatric Emergency Medicine Course) is being run as one of the pre-conference workshops for ICEM 2016 at Red Cross War Memorial Children’s Hospital today. OpenAirway is present, assisting with the airway stations. Course instructors have given their blessing to host some of the supplementary material online for the #FOAM community, so we have created a PEMC resources page here! More content will be added as it becomes available.
This month’s edition of Anesthesiology News features a worthwhile piece from Prof John Doyle, in which he poses 7 questions on the current state of airway management to 6 airway experts from around the world (Abdelmalak, Cooper, Frova, Rosenblatt, Spiegel and Doyle himself), and collates their responses into a dialogue. Definitely worth reading to determine what some (certainly not all) of the biggest names in the world are thinking on:
You can read the article on the Anesthesiology News site by clicking here or the image above, or download the PDF version here.
For what it is worth, here are my own answers, distilled into one-liners. I’m very willing to enter into discussions about them!
There are a lot of excellent (and complementary) views expressed in the article, which are worth reading. Check it out!
Need a quick reference for paediatric supraglottic airway sizes? Save these images on your phone/tablet or print them for the wall 🙂
Without getting into a lengthy argument about what constitutes a second-generation supraglottic airway (or an extraglottic vs. supraglottic, for that matter), if you are using an SGA with a gastric drainage port (such as the LMA Proseal, LMA Supreme, i-Gel, etc) you have a very simple and easy conduit to insert a mid-oesophageal thermistor probe to monitor patient temperature.
Ideally, to achieve a mid-oesophageal position, you need the probe to extend 5-10 cm past the tip of the SGA, so try and remember to measure the probe against the device before insertion and mark it with a small piece of dressing tape. This has an added advantage of helping prevent air leak via the drainage tube if your SGA is not seated or strapped ideally. Of course, this means that drainage via the oespophageal lumen is significantly impaired, and you cannot insert a gastric tube without removing the probe first, so it is only suited to patients in whom you have little concern regarding reflux and aspiration. Devices that offer twin drainage tubes (such as the 3gLM) are a way around this problem.
The TotalTrack is a new video laryngeal mask that allows intubation through the device without interruption of ventilation. Recruitment of the first independent clinical trial is well underway in Cape Town, with European studies nearing commencement. Here is an example video taken with the device, showing intubation in a patient with severe obstructive sleep apnoea (OSA).
https://www.youtube.com/watch?v=Fjp0WTz2sD4
Blinded intubation through the 3gLM SGA, as viewed by a video endoscope riding inside a Parker Flex-Tip ETT.