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Online ISSN 1827-1596
Ingelmo P. M. 1, Parini R. 2, Grimaldi M. 3, Mauri F. 1, Romagnoli M. 4, Tagliabue G. 1, Somaini M. 1, Sahillioglu E. 5, Frawley G. 6
1 First Service of Anesthesia and Intensive Care, San Gerardo Hospital, Monza, Italy;
2 Rare Metabolic Diseases Unit, Department of Pediatrics and Maternal Care, San Gerardo Hospital, Monza, Italy; 3 Department of Radiology and Radiodiagnostics, San Gerardo Hospital, Monza, Italy;
4 Department of Ear Nose Throat Surgery, San Gerardo Hospital, Monza, Italy;
5 Department of Anesthesiology and Reanimation, Kocaeli University Medical Faculty, Kocaeli, Turkey;
6 Department of Anesthesia, Royal Children’s Hospital, Melbourne, Australia
BACKGROUND. Accumulation of glycosaminoglycans is known to cause significant problems in the anesthetic management of children with mucopolysaccharidoses (MPS). Clinical and standard radiological evaluation may convey insufficient information about the upper airway and trachea in children with MPS. Multidetector computed tomography (MDCT) images have been used to define the central airway and previous studies have recommended this tool to assess the airway of children who are considered at risk of difficult intubation. However, MDCT has not been recommended in MPS children. The aim of this clinical scenario study was to verify whether information from MDCT reconstruction of the airway is useful in airway management planning of children with MPS.
METHODS: In a two phase questionnaire-based study, 26 pediatric anesthesiologists were asked to produce airway management plans for 5 children with MPS. An initial plan for airway control was reported after assessment of standard preoperative anesthetic charts. A subsequent airway strategy was then described after reviewing tracheal MDCT images of each patient.
RESULTS: MDCT images provided additional clinically-relevant information in 87% (95% CI: 79-92%) of the evaluations. Reduction of tracheal size was the most common finding provided by the MDCT images. After reviewing the MDCT images, anesthesiologists changed their primary airway device selection in 21% of the evaluations (P=0.01).
CONCLUSION: Airway reconstruction using MDCT images from a previous CT scan may provide a useful assessment tool for preoperative airway evaluation and planning in MPS children.