Management of the child's airway under anaesthesia: The French guidelines

Christophe Dadure; Nada Sabourdin; Francis Veyckemans; Florence Babre; Nathalie Bourdaud; Souhayl Dahmani; Mathilde De Queiroz; Jean-Michel Devys; Marie-Claude Dubois; Delphine Kern; Anne Laffargue; Marc Laffon; Corinne Lejus-Bourdeau; Karine Nouette-Gaulain; Gilles Orliaguet; Etienne Gayat; Lionel Velly; Nadège Salvi; Chrystelle Sola

doi:10.1016/j.accpm.2019.02.004

Management of the child's airway under anaesthesia: The French guidelines

Anaesth Crit Care Pain Med. 2019 Dec;38(6):681-693. doi: 10.1016/j.accpm.2019.02.004. Epub 2019 Feb 23.

Authors

Christophe Dadure¹, Nada Sabourdin², Francis Veyckemans³, Florence Babre⁴, Nathalie Bourdaud⁵, Souhayl Dahmani⁶, Mathilde De Queiroz⁵, Jean-Michel Devys⁷, Marie-Claude Dubois⁷, Delphine Kern⁸, Anne Laffargue³, Marc Laffon⁹, Corinne Lejus-Bourdeau¹⁰, Karine Nouette-Gaulain¹¹, Gilles Orliaguet¹², Etienne Gayat¹³, Lionel Velly¹⁴, Nadège Salvi¹⁵, Chrystelle Sola¹⁶

Affiliations

¹ Département d'anesthesiologie réanimation femme-mère-enfant, CHU de Lapeyronie, institut de génomique fonctionnelle, UMR 5203 CNRS - U 1191 Inserm, université de Montpellier, 34285 Montpellier, France. Electronic address: c-dadure@chu-montpellier.fr.
² Département d'anesthésiologie-réanimation hôpital Armand Trousseau, AP-HP, 26, avenue du Dr Arnold-Netter, 75012 Paris, France.
³ Department of paediatric anaesthesia, Jeanne de Flandre hospital, university hospitals of Lille, 59037 Lille, France.
⁴ Department of anaesthesia, Bergonié institute, 33000 Bordeaux, France.
⁵ Département d'Anesthésiologie Réanimation Pédiatrique, Hôpital Femme Mère Enfant, 69677 Bron, France.
⁶ Department of anaesthesia and intensive care. Robert-Debré university hospital, assistance publique Hôpitaux de Paris, Paris Diderot University, Paris Sorbonne Cité, Paris, Paris Diderot University (Paris VII), PRES Paris Sorbonne Cité, Paris, DHU PROTECT, Inserm U1141, Robert-Debré University Hospital, 75019 Paris, France.
⁷ Service d'anesthésie-réanimation, fondation ophtalmologique Adolphe de Rothschild, 25, rue Manin, 75019 Paris, France.
⁸ Departments of anaesthesia and intensive care, university hospital of Toulouse, place du Dr Baylac, TSA 40031, 31059 Toulouse cedex 9, France.
⁹ Department of anesthesia and intensive care, university hospital and medical university François-Rabelais, Tours, France.
¹⁰ Service d'anesthesie réanimation chirurgicale, Hôtel Dieu, Hôpital Mère Enfant, CHU de Nantes, 44093 Nantes cedex, France.
¹¹ Service d'anesthésie réanimation Pellegrin, hôpital Pellegrin, CHU de Bordeaux, place Amélie Raba Léon, 33000 Bordeaux, France; Université Bordeaux, Inserm U12-11, laboratoire de maladies rares: génétique et métabolisme (MRGM), 176, rue Léo-Saignat, 33000 Bordeaux, France.
¹² Department of anaesthesia and intensive care, assistance publique Hôpitaux de Paris, Necker-Enfants Malades hospital, EA08 pharmacologie et évaluation des thérapeutiques chez l'enfant et la femme enceinte, Paris Descartes University (Paris V), PRES Paris Sorbonne Cité, 75743 Paris, France.
¹³ Department of anesthesiology and Intensive care, Saint Louis, Lariboisière university hospital, université Paris Diderot, BioCANVAS, UMR-S 942, Inserm, 75010 Paris, France.
¹⁴ Service d'anesthesie réanimation, CHU de Timone adultes, 264, rue St Pierre, 13005 MeCA, institut de neurosciences de la Timone, UMR 7289, Aix Marseille université, Marseille, France.
¹⁵ Department of anaesthesia and intensive care, assistance publique Hôpitaux de Paris, Necker-Enfants Malades Hospital, 75743 Paris, France.
¹⁶ Département d'anesthesiologie réanimation femme-mère-enfant, CHU de Lapeyronie, institut de génomique fonctionnelle, UMR 5203 CNRS - U 1191 Inserm, université de Montpellier, 34285 Montpellier, France.

PMID: 30807876
DOI: 10.1016/j.accpm.2019.02.004

Abstract

Objective: To provide French guidelines about "Airway management during paediatric anaesthesia".

Design: A consensus committee of 17 experts from the French Society of Anaesthesia and Intensive Care Medicine (Société Française d'Anesthésie-Réanimation, SFAR) and the Association of French speaking paediatric anaesthesiologists and intensivists (Association Des Anesthésistes Réanimateurs Pédiatriques d'Expression Francophone, ADARPEF) was convened. The entire process was conducted independently of any industry funding. The authors followed the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE®) system to assess the quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasised. Few recommendations were not graded.

Methods: The panel focused on 7 questions: 1) Supraglottic Airway devices 2) Cuffed endotracheal tubes 3) Videolaryngoscopes 4) Neuromuscular blocking agents 5) Rapid sequence induction 6) Airway device removal 7) Airway management in the child with recent or ongoing upper respiratory tract infection. Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. The analysis of the literature and the redaction of the recommendations were then conducted according to the GRADE® methodology.

Results: The SFAR Guideline panel provides 17 statements on "airway management during paediatric anaesthesia". After two rounds of discussion and various amendments, a strong agreement was reached for 100% of the recommendations. Of these recommendations, 6 have a high level of evidence (Grade 1 ± ), 6 have a low level of evidence (Grade 2 ± ) and 5 are experts' opinions. No recommendation could be provided for 3 questions.

Conclusions: Substantial agreement exists among experts regarding many strong recommendations for paediatric airway management.

Keywords: Airway; Children; Guidelines; Management.

Publication types

Consensus Development Conference
Practice Guideline

MeSH terms

Administration, Topical
Airway Extubation / methods
Airway Management / methods
Airway Management / standards*
Algorithms
Child
Child, Preschool
Equipment Design
France
Humans
Infant
Intubation, Intratracheal / instrumentation
Intubation, Intratracheal / methods
Laryngoscopy / instrumentation
Laryngoscopy / methods
Lidocaine / administration & dosage
Neuromuscular Nondepolarizing Agents / administration & dosage
Rapid Sequence Induction and Intubation
Respiratory Tract Infections
Video Recording / instrumentation
Video Recording / methods

Substances

Neuromuscular Nondepolarizing Agents
Lidocaine