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Airway management in neonates and infants is a critical aspect of pediatric anesthesia and emergency medicine. Due to their unique anatomical and physiological characteristics, neonates and infants are at higher risk for adverse airway events, especially during surgery, resuscitation, and intensive care. To address this, the ESAIC and BJA have released the first evidence-based, consensus-driven guidelines focusing specifically on this vulnerable age group (BJA, 2024). These guidelines represent a collaborative effort from 23 global experts in pediatric airway management, aiming to provide structured, clinically applicable recommendations. Why are these guidelines important? High complication rates: Neonates and infants show a significantly higher incidence of difficult airway events compared to older children and adults. Lack of pediatric-specific equipment and training: Most airway tools and protocols have been developed for adults. Anatomical complexity: Large tongues, high larynx, short necks, and narrow airways complicate both visualization and intubation. Key areas of focus The guidelines address seven critical domains of neonatal and infant airway management: Preoperative assessment and preparation Medication use Intubation techniques and algorithms Difficult airway identification and management Tracheal intubation confirmation Safe tracheal extubation Human factors and training Recommendations at a glance Top 10 clinical recommendations: Use medical history and physical examination to identify difficult airways. Ensure adequate sedation or general anesthesia. Administer neuromuscular blockers if spontaneous breathing is not needed. Use a videolaryngoscope with an age-adapted blade as a first-line intubation technique. Apply apnoeic oxygenation during tracheal intubation. Consider supraglottic airway devices (SGAs) for failed intubation scenarios. Limit tracheal intubation attempts to reduce trauma and hypoxia. Use a stylet for hyperangulated blades or anterior larynx positions. Confirm intubation with clinical assessment and end-tidal CO₂ monitoring. Post-extubation, apply HFNO, CPAP, or NIPPV if needed. Step-by-Step Preoperative phase Preoperative Airway Assessment Recommendation: Use the patient’s medical history and a physical exam to predict difficult […]
May 16, 2025
A newly published clinical investigation in the British Journal of Anaesthesia (May 2025 issue) reveals compelling evidence linking glucagon-like peptide-1 receptor agonists (GLP-1RAs) to impaired gastric emptying (IGE). These findings highlight potential risks for patients undergoing surgery, especially concerning pulmonary aspiration during anesthesia. As GLP-1RAs continue to grow in popularity for managing type 2 diabetes and obesity, this pharmacovigilance study calls for increased awareness and careful perioperative planning among clinicians. Understanding GLP-1 receptor agonists What are GLP-1RAs? GLP-1 receptor agonists are a class of injectable and oral medications that mimic the natural incretin hormone, GLP-1. They enhance insulin secretion, suppress glucagon release, slow gastric emptying, and promote satiety. These actions improve glycemic control and support weight loss. Commonly prescribed GLP-1RAs: Exenatide (Byetta, Bydureon) Liraglutide (Victoza, Saxenda) Dulaglutide (Trulicity) Semaglutide (Ozempic, Wegovy, Rybelsus) Tirzepatide (Mounjaro) Study overview: What was investigated? Researchers analyzed data from the U.S. FDA Adverse Event Reporting System (FAERS), spanning from Q1 2004 to Q1 2024. The objective was to determine the association between GLP-1RA use and impaired gastric emptying (IGE), particularly in the context of anesthesia and surgical safety. Key methods: Extraction of IGE reports labeled under the term “impaired gastric emptying” in MedDRA. Identification of the top 10 drugs linked to IGE. Disproportionality analysis using reporting odds ratios (ROR). Logistic regression to evaluate the influence of age, sex, and weight. Kaplan-Meier and Weibull analysis to determine time-to-onset trends. Study results: what did they find? 1. GLP-1RAs dominate IGE-related reports Among the top 10 drugs associated with IGE events, five were GLP-1 receptor agonists: Dulaglutide: 262 cases Semaglutide: 246 cases Exenatide: 183 cases Tirzepatide: 181 cases Liraglutide: 110 cases Together, they accounted for 49.5% (982 of 1982) of the IGE reports among these top 10 drugs. Despite being only a subset of all drugs in the FAERS, […]
May 15, 2025
Anterior cruciate ligament reconstruction (ACLR) is a frequent orthopedic procedure, particularly among young, active individuals and athletes. Despite advances in surgical technique and perioperative care, managing postoperative pain remains a critical component of ensuring early mobilization, optimal rehabilitation, and high patient satisfaction. Inadequate pain control can delay recovery, prolong opioid use, and hinder long-term functional outcomes Over the years, regional anesthesia has emerged as an important adjunct in multimodal analgesic strategies for ACLR. Among these, the femoral triangle block (FTB), a variant of the adductor canal block, has become increasingly popular for its ability to provide anterior knee analgesia with minimal motor impairment. However, posterior knee pain remains a challenging area, often inadequately addressed by FTB alone. The interspace between the popliteal artery and the capsule of the posterior knee (iPACK) block was developed to target sensory nerves innervating the posterior capsule without affecting the tibial or peroneal nerves, thus preserving motor function. The iPACK has shown promising results in total knee arthroplasty (TKA), but its role in ACLR is still being defined. This randomized controlled trial evaluated whether adding an iPACK block to a standard analgesic regimen, including FTB and local infiltration, provides superior pain control and functional outcomes after ACLR Study objective and methods The study aimed to determine if the addition of an iPACK block to FTB reduces opioid consumption and improves pain scores and functional outcomes following ACLR. Design: Single-blind, randomized controlled trial conducted at a French academic hospital. Participants: 90 adult patients undergoing primary ACLR under general anesthesia. FTB group: Received ultrasound-guided FTB with 15 mL of 0.2% ropivacaine. FTB + iPACK group: Received the same FTB plus an iPACK block (25 mL of 0.2% ropivacaine) targeting the posterior knee capsule. Common to both groups: Surgical infiltration analgesia with 20 mL of ropivacaine, single-shot spinal […]
May 13, 2025
