Papers by Narasimhan Jagannathan
BJA: British Journal of Anaesthesia, Sep 1, 2016
Airway management remains a significant cause of morbidity and mortality in anaesthetized childre... more Airway management remains a significant cause of morbidity and mortality in anaesthetized children. Children with difficult direct laryngoscopy are an especially vulnerable group. However, most paediatric anaesthetics are administered by generalists without advanced paediatric training. This editorial is aimed at all practitioners who care for children, particularly those without advanced paediatric anaesthesia training. Our goal is to convey three important points: (i) the contributing factors for severe complications in this population; (ii) the important role of the supraglottic airway (SGA) in managing these patients; and (iii) the Editorials | i3
BJA: British Journal of Anaesthesia, Jul 1, 2018
A non-synonymous single nucleotide polymorphism in an OPRM1 splice variant is associated with fen... more A non-synonymous single nucleotide polymorphism in an OPRM1 splice variant is associated with fentanyl-induced emesis in women undergoing minor gynaecological surgery. PLoS One 2012; 7: e48416 18. Zhang W, Yuan JJ, Kan QC, Zhang LR, Chang YZ, Wang ZY. Study of the OPRM1 A118G genetic polymorphism associated with postoperative nausea and vomiting induced by fentanyl intravenous analgesia.
Updates from the Pediatric Difficult Airway Registry
Current Anesthesiology Reports, Jun 22, 2023
Supraglottic Airways in Pediatric Patients: An Overview
Airway Management of the Infant
Role Of The Airway Community
The Role of Supraglottic Airways in Pediatric Emergency Medicine
Clinical Pediatric Emergency Medicine, Sep 1, 2015
Supraglottic airway (SGA) devices have been shown to be a critical tool in pediatric airway manag... more Supraglottic airway (SGA) devices have been shown to be a critical tool in pediatric airway management. The role of the SGA in emergency scenarios has increased dramatically, as its advantages are widely recognized. Studies have shown that SGAs are safe and effective in providing lifesaving oxygenation and gas exchange in both the normal and difficult pediatric airway and during resuscitation. They allow for rapid oxygenation and ventilation in the vast majority of children and are the ideal rescue device for failed facemask ventilation. They are also the ideal conduits to facilitate tracheal intubation. Newer SGA devices have design features to overcome limitations found in older devices. This narrative review aims to discuss the role of SGAs for pediatric emergency medicine.
Anesthesia & Analgesia, 2011
BACKGROUND: The air-Q™ Intubating Laryngeal Airway (ILA) (Cookgas LLC, Mercury Medical, Clearwate... more BACKGROUND: The air-Q™ Intubating Laryngeal Airway (ILA) (Cookgas LLC, Mercury Medical, Clearwater, FL) is a supraglottic airway device available in pediatric sizes, with design features to facilitate passage of cuffed tracheal tubes when used to guide tracheal intubation. We designed this prospective observational study of the ILA to assess the ease of its placement in paralyzed pediatric patients, determine its position and alignment to the larynx using a fiberoptic bronchoscope, gauge its efficacy as a conduit for fiberoptic intubation with cuffed tracheal tubes, and evaluate the ability to remove the ILA without dislodgement of the tracheal tube after successful tracheal intubation. METHODS: One hundred healthy children, aged 6 months to 8 years, ASA physical status I to II, and scheduled for elective surgery requiring general endotracheal anesthesia were enrolled in this prospective study. Based on the manufacturer's guidelines, each patient received either a size 1.5 or 2.0 ILA according to their weight. The number of attempts for successful insertion, leak pressures, fiberoptic grade of view, number of attempts and time for tracheal intubation, time for ILA removal, and complications were recorded. RESULTS: ILA placement, fiberoptic tracheal intubation, and ILA removal were successful in all patients. The size 1.5 ILA cohort had significantly higher rates of epiglottic downfolding compared with the size 2.0 ILA cohort (P Ͻ 0.001), despite adequate ventilation variables. When comparing fiberoptic grade of view to weight, a moderate negative correlation was found (r ϭ Ϫ0.41, P Ͻ 0.001), indicating that larger patients tended to have better fiberoptic grades of view. The size 1.5 ILA cohort had a significantly longer time to intubation (P ϭ 0.04) compared with the size 2.0 ILA cohort. However, this difference may not be clinically significant because there was a large overlap of confidence bounds in the average times of the size 1.5 ILA (27.0 Ϯ 13.0 seconds) and size 2.0 ILA cohorts (22.7 Ϯ 6.9 seconds). When comparing weight to time to tracheal intubation, a weak correlation that was not statistically significant was found (r ϭ Ϫ0.17, P ϭ 0.09), showing that time to intubation did not differ significantly according to weight, despite higher fiberoptic grades in smaller patients. CONCLUSIONS: The ILA was easy to place and provided an effective conduit for tracheal intubation with cuffed tracheal tubes in children with normal airways. Additionally, removal of the ILA after successful intubation could be achieved quickly and without dislodgement of the tracheal tube. Because of the higher incidence of epiglottic downfolding in smaller patients, the use of fiberoptic bronchoscopy is recommended to assist with tracheal intubation through this device.
Difficult or impossible facemask ventilation in children with difficult tracheal intubation: a retrospective analysis of the PeDI registry
British Journal of Anaesthesia
Anaesthesia
Respiratory adverse events in adults with COVID-19 undergoing general anaesthesia can be life-thr... more Respiratory adverse events in adults with COVID-19 undergoing general anaesthesia can be life-threatening. However, there remains a knowledge gap about respiratory adverse events in children with COVID-19. We created an international observational registry to collect airway management outcomes in children with COVID-19 who were having a general anaesthetic. We hypothesised that children with confirmed or suspected COVID-19 would experience more hypoxaemia and complications than those without. Between 3 April 2020 and 1 November 2020, 78 international centres participated. In phase 1, centres collected outcomes on all children (age ≤ 18 y) having a general anaesthetic for 2 consecutive weeks. In phase 2, centres recorded outcomes for children with test-confirmed or suspected COVID-19 (based on symptoms) having a general anaesthetic. We did not study children whose tracheas were already intubated. The primary outcome was the incidence of hypoxaemia during airway management. Secondary outcomes included: incidence of other complications; and first-pass success rate for tracheal intubation. In total, 7896 children were analysed (7567 COVID-19 negative and 329 confirmed or presumed COVID-19 positive). The incidence of hypoxaemia during airway management was greater in children who were COVID-19 positive (24 out of 329 (7%) vs. 214 out of 7567 (3%); OR 2.70 (95%CI 1.70-4.10)). Children who had symptoms of COVID-19 had a higher incidence of hypoxaemia compared with those who were asymptomatic (9 out of 51 (19%) vs. 14 out of 258 (5%), respectively; OR 3.7 (95%CI 1.5-9.1)). Children with confirmed or presumed COVID-19 have an increased risk of hypoxaemia during airway management in conjunction with general anaesthesia.
Patient and operative factors associated with unanticipated intensive care admission and outcomes following posterior fossa decompressions in children: A retrospective study
Pediatric Anesthesia
IntroductionPosterior fossa decompression for Chiari I Malformation is a common pediatric neurosu... more IntroductionPosterior fossa decompression for Chiari I Malformation is a common pediatric neurosurgical procedure. We sought to identify the impact of anesthesia‐related intraoperative complications on unanticipated admission to the intensive care unit and outcomes following posterior fossa decompression.MethodsMedical records of all patients <18 years who underwent surgery for Chiari I malformation between 1/1/09 and 1/31/21 at the Ann & Robert H. Lurie Children's Hospital of Chicago were included. Records were reviewed for patient characteristics, anesthesia‐related intraoperative complications, postoperative complications, and surgical outcomes. The primary outcome was the incidence of unanticipated admission to the intensive care unit, and the primary variable of interest was an anesthesia‐related intraoperative complication. Patient, surgical characteristics, and year of surgery were also compared between patients with and without an unanticipated admission to the intens...
Ventilation through small‐bore airways in children by implementing active expiration
Pediatric Anesthesia, 2021
Management of narrowed airways can be challenging, especially in the smallest patients. This educ... more Management of narrowed airways can be challenging, especially in the smallest patients. This educational review focusses on active expiration through small‐bore airways with the Ventrain (Ventinova Medical, Eindhoven, The Netherlands). Manual ventilation with the Ventrain establishes inspiratory and expiratory flow control: By setting an appropriate flow, the volume of gas insufflated over time can be controlled and expiration through a small‐bore airway is expedited by jet‐flow generated suction, coined “expiratory ventilation assistance” (EVA). This overcomes the inherent risks of emergency jet ventilation especially in pediatric airway emergencies. Active expiration by EVA has been clinically introduced to turn a “straw in the airway” into a lifesaver allowing not only for quick and reliable reoxygenation but also adequate ventilation. As well as managing airway emergencies, ventilating through small‐bore airways by applying EVA implements new options for pediatric airway management in elective interventional procedures. Safe application of EVA demands a thorough understanding of the required equipment, the principle and function of the Ventrain, technical prerequisites, clinical safety measures, and, most importantly, appropriate training.
Supraglottic Airway Equipment and Techniques
Supraglottic Airways in Pediatric Patients: An Overview
Management of the Paediatric Difficult Airway
Somatic blockade of the head and neck
Journal of Head & Neck Anesthesia, 2020
The design of the perfect pediatric supraglottic airway device
Pediatric Anesthesia, 2019
The design evolution of the pediatric supraglottic airway device has experienced a long and produ... more The design evolution of the pediatric supraglottic airway device has experienced a long and productive journey. We have a wealth of clinical studies to support progress and advancements in pediatric clinical practice. While all of the supraglottic airway devices have been used successfully in millions of children, it is important to be aware of design advantages and disadvantages of the different models of supraglottic airway devices. Current pediatric supraglottic airway devices may be improved in design to be more ideal. Industry‐changing technological advancements are likely to occur in the near future, which may further improve clinical performance of these devices.
International Journal of Ophthalmology, 2019
• AIM: To report a large series of children having Nd:YAG laser capsulotomy in the operating room... more • AIM: To report a large series of children having Nd:YAG laser capsulotomy in the operating room using the lateral decubitus position. • METHODS: Medical records of children who underwent Nd:YAG laser capsulotomy in the operating room at Ann & Robert H. Lurie Children's Hospital of Chicago between September 2008 and April 2017 were reviewed. Induction of general anesthesia and intubation was performed in the supine position after which the patient was placed in lateral decubitus position. The Nd:YAG laser capsulotomy was performed using a standard protocol. At the completion of the procedure, the patient was turned back into the supine position and extubated. • RESULTS: This study included 87 eyes of 60 patients. Patient's age ranged from 1 to 18y (mean 6.4±4.1y). In most cases (84/87, 97%), the procedure was performed under general anesthesia. In all cases, good focus on the membrane was achieved, and the procedure was performed successfully. There were no intraoperative ocular or anesthesia-related complications. • CONCLUSION: When performing Nd:YAG laser capsulotomy in the operating room, the lateral decubitus position allows an easy and safe approach without the risk of potentially devastating complications that have been associated with the previously described sitting and prone positions.
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Papers by Narasimhan Jagannathan