We can help make better decisions ahead of time and probably spend less time in the operating room with a child under anesthesia if we have a good look at what that child's airway looks like before we start.
Three dimensions are important for lung isolation: tracheal diameter (particularly AP diameter), bronchial diameters, and the length of the right main stem bronchus between carina and right upper lobe takeoff.
Regular endotracheal tube is the most common device for lung isolation in neonates because it is relatively straightforward to mainstem into the left bronchus, which has a good landing zone for the balloon.
Unrepaired single ventricle patients are sensitive to changes in ventilation because they can have swings in circulation direction based on pulmonary vascular resistance.
Bronchial blockers can be helpful in kids with abnormal parenchyma when higher ventilatory pressures are needed but higher insufflation pressures should be avoided.
Patients with compliance abnormalities often require higher peak inspiratory or mean airway pressures, resulting in the need for very high insufflation pressures.
QUAD #7 Anesthesia for Thoracoscopic Techniques with Dr. Nathaniel Tighe
▶Ep 20 · 0:53
clinicalBirth history and patient size are important preoperative considerations for esophageal atresia repair.↗
▶Ep 20 · 0:53
quoteBirth history is really important and how big the child is.↗
▶Ep 20 · 0:57
clinicalPhysiologic status from ventilation and cardiac standpoints is particularly important in preoperative assessment.↗
▶Ep 20 · 1:13
quoteWe can help make better decisions ahead of time and probably spend less time in the operating room with a child under anesthesia if we have a good look at what that child's airway looks like before we start.↗
▶Ep 20 · 1:13
clinicalPreoperative visualization of the child's airway allows better decision-making and potentially less time under anesthesia.↗
▶Ep 20 · 1:33
quoteAkinesis or keeping the kids still can be very challenging in these small children, especially when intraoperative neuromonitoring is involved.↗
▶Ep 20 · 1:33
clinicalAkinesis (keeping children still) can be very challenging in small children, especially when intraoperative neuromonitoring is involved.↗
▶Ep 20 · 2:25
quoteAs far as the anesthetic goes, it precludes our use of neuromuscular blocking drugs like urouronium, Becuronium, and others.↗
▶Ep 20 · 2:25
clinicalIntraoperative neuromonitoring precludes the use of neuromuscular blocking drugs like rocuronium and vecuronium.↗
▶Ep 20 · 3:00
clinicalPatients with compliance abnormalities often require higher peak inspiratory or mean airway pressures, resulting in the need for very high insufflation pressures.↗
▶Ep 20 · 3:20
clinicalLung isolation utility is restricted by patient size and airway anatomy and requires expertise and specialized equipment.↗
▶Ep 20 · 3:34
quoteThere's 3 dimensions that are really important.↗
▶Ep 20 · 3:34
clinicalThree dimensions are important for lung isolation: tracheal diameter (particularly AP diameter), bronchial diameters, and the length of the right main stem bronchus between carina and right upper lobe takeoff.↗
▶Ep 20 · 4:05
quoteRegular old endotracheal tube is probably the most common in neonates because it's relatively straightforward to mainstem.↗
▶Ep 20 · 4:05
clinicalRegular endotracheal tube is the most common device for lung isolation in neonates because it is relatively straightforward to mainstem into the left bronchus, which has a good landing zone for the balloon.↗
▶Ep 20 · 4:24
clinicalBronchial blockers or Fogarty catheters require enough space between the carina and right upper lobe takeoff for balloon placement.↗
▶Ep 20 · 4:39
clinicalIn kids with a pig bronchus, bronchial blocker placement becomes very difficult and may require selective lobar blockade.↗
▶Ep 20 · 4:58
clinicalBronchial blockers can be helpful in kids with abnormal parenchyma when higher ventilatory pressures are needed but higher insufflation pressures should be avoided.↗
▶Ep 20 · 5:55
clinicalUnrepaired single ventricle patients are sensitive to changes in ventilation because they can have swings in circulation direction based on pulmonary vascular resistance.↗
▶Ep 20 · 5:55
quoteUnrepaired single ventricle kids are really sensitive to changes in their ventilation.↗
▶Ep 20 · 6:18
clinicalInsufflation causes changes in preload, and patients with passive pulmonary circulations are particularly sensitive to this insufflation.↗
Nathan's statements about Esophageal Atresia21 statements
QUAD #7 Anesthesia for Thoracoscopic Techniques with Dr. Nathaniel Tighe
▶Ep 29 · 0:53
quoteBirth history is really important and how big the child is.↗
▶Ep 29 · 0:53
clinicalBirth history and patient size are important preoperative considerations for esophageal atresia repair.↗
▶Ep 29 · 0:57
clinicalPhysiologic status from ventilation and cardiac standpoints is particularly important in preoperative assessment.↗
▶Ep 29 · 1:13
quoteWe can help make better decisions ahead of time and probably spend less time in the operating room with a child under anesthesia if we have a good look at what that child's airway looks like before we start.↗
▶Ep 29 · 1:13
clinicalPreoperative visualization of the child's airway allows better decision-making and potentially less time under anesthesia.↗
▶Ep 29 · 1:33
quoteAkinesis or keeping the kids still can be very challenging in these small children, especially when intraoperative neuromonitoring is involved.↗
▶Ep 29 · 1:33
clinicalAkinesis (keeping children still) can be very challenging in small children, especially when intraoperative neuromonitoring is involved.↗
▶Ep 29 · 2:25
quoteAs far as the anesthetic goes, it precludes our use of neuromuscular blocking drugs like urouronium, Becuronium, and others.↗
▶Ep 29 · 2:25
clinicalIntraoperative neuromonitoring precludes the use of neuromuscular blocking drugs like rocuronium and vecuronium.↗
▶Ep 29 · 3:00
clinicalPatients with compliance abnormalities often require higher peak inspiratory or mean airway pressures, resulting in the need for very high insufflation pressures.↗
▶Ep 29 · 3:20
clinicalLung isolation utility is restricted by patient size and airway anatomy and requires expertise and specialized equipment.↗
▶Ep 29 · 3:34
clinicalThree dimensions are important for lung isolation: tracheal diameter (particularly AP diameter), bronchial diameters, and the length of the right main stem bronchus between carina and right upper lobe takeoff.↗
▶Ep 29 · 3:34
quoteThere's 3 dimensions that are really important.↗
▶Ep 29 · 4:05
quoteRegular old endotracheal tube is probably the most common in neonates because it's relatively straightforward to mainstem.↗
▶Ep 29 · 4:05
clinicalRegular endotracheal tube is the most common device for lung isolation in neonates because it is relatively straightforward to mainstem into the left bronchus, which has a good landing zone for the balloon.↗
▶Ep 29 · 4:24
clinicalBronchial blockers or Fogarty catheters require enough space between the carina and right upper lobe takeoff for balloon placement.↗
▶Ep 29 · 4:39
clinicalIn kids with a pig bronchus, bronchial blocker placement becomes very difficult and may require selective lobar blockade.↗
▶Ep 29 · 4:58
clinicalBronchial blockers can be helpful in kids with abnormal parenchyma when higher ventilatory pressures are needed but higher insufflation pressures should be avoided.↗
▶Ep 29 · 5:55
quoteUnrepaired single ventricle kids are really sensitive to changes in their ventilation.↗
▶Ep 29 · 5:55
clinicalUnrepaired single ventricle patients are sensitive to changes in ventilation because they can have swings in circulation direction based on pulmonary vascular resistance.↗
▶Ep 29 · 6:18
clinicalInsufflation causes changes in preload, and patients with passive pulmonary circulations are particularly sensitive to this insufflation.↗
Nathan's statements about Esophageal Atresia21 statements
QUAD #7 Anesthesia for Thoracoscopic Techniques with Dr. Nathaniel Tighe
▶Ep 56 · 0:53
clinicalBirth history and patient size are important preoperative considerations for esophageal atresia repair.↗
▶Ep 56 · 0:53
quoteBirth history is really important and how big the child is.↗
▶Ep 56 · 0:57
clinicalPhysiologic status from ventilation and cardiac standpoints is particularly important in preoperative assessment.↗
▶Ep 56 · 1:13
quoteWe can help make better decisions ahead of time and probably spend less time in the operating room with a child under anesthesia if we have a good look at what that child's airway looks like before we start.↗
▶Ep 56 · 1:13
clinicalPreoperative visualization of the child's airway allows better decision-making and potentially less time under anesthesia.↗
▶Ep 56 · 1:33
clinicalAkinesis (keeping children still) can be very challenging in small children, especially when intraoperative neuromonitoring is involved.↗
▶Ep 56 · 1:33
quoteAkinesis or keeping the kids still can be very challenging in these small children, especially when intraoperative neuromonitoring is involved.↗
▶Ep 56 · 2:25
clinicalIntraoperative neuromonitoring precludes the use of neuromuscular blocking drugs like rocuronium and vecuronium.↗
▶Ep 56 · 2:25
quoteAs far as the anesthetic goes, it precludes our use of neuromuscular blocking drugs like urouronium, Becuronium, and others.↗
▶Ep 56 · 3:00
clinicalPatients with compliance abnormalities often require higher peak inspiratory or mean airway pressures, resulting in the need for very high insufflation pressures.↗
▶Ep 56 · 3:20
clinicalLung isolation utility is restricted by patient size and airway anatomy and requires expertise and specialized equipment.↗
▶Ep 56 · 3:34
clinicalThree dimensions are important for lung isolation: tracheal diameter (particularly AP diameter), bronchial diameters, and the length of the right main stem bronchus between carina and right upper lobe takeoff.↗
▶Ep 56 · 3:34
quoteThere's 3 dimensions that are really important.↗
▶Ep 56 · 4:05
quoteRegular old endotracheal tube is probably the most common in neonates because it's relatively straightforward to mainstem.↗
▶Ep 56 · 4:05
clinicalRegular endotracheal tube is the most common device for lung isolation in neonates because it is relatively straightforward to mainstem into the left bronchus, which has a good landing zone for the balloon.↗
▶Ep 56 · 4:24
clinicalBronchial blockers or Fogarty catheters require enough space between the carina and right upper lobe takeoff for balloon placement.↗
▶Ep 56 · 4:39
clinicalIn kids with a pig bronchus, bronchial blocker placement becomes very difficult and may require selective lobar blockade.↗
▶Ep 56 · 4:58
clinicalBronchial blockers can be helpful in kids with abnormal parenchyma when higher ventilatory pressures are needed but higher insufflation pressures should be avoided.↗
▶Ep 56 · 5:55
clinicalUnrepaired single ventricle patients are sensitive to changes in ventilation because they can have swings in circulation direction based on pulmonary vascular resistance.↗
▶Ep 56 · 5:55
quoteUnrepaired single ventricle kids are really sensitive to changes in their ventilation.↗
▶Ep 56 · 6:18
clinicalInsufflation causes changes in preload, and patients with passive pulmonary circulations are particularly sensitive to this insufflation.↗
