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BACKGROUND: Pediatric airway management traditionally emphasizes strict adherence to age-based laryngoscope blade size recommendations, despite limited empirical validation. OBJECTIVES: To evaluate whether intubation performance varies across a range of blade sizes, and whether a Macintosh 2 blade performs comparably across multiple pediatric age groups in a simulation setting. METHODS: We conducted a randomized crossover simulation study using three pediatric airway manikins (neonate, infant, and child age groups). Emergency medicine residents and faculty physicians performed intubations using multiple laryngoscope blade types and sizes, including standard and nonstandard options. Primary outcomes were intubation time and first-attempt success. Secondary outcomes included complications and operator-rated ease of glottic view and tube passage. Between-blade differences were estimated with 95% confidence intervals. RESULTS: Across manikin sizes and blade types, intubation times were short and first-attempt success rates exceeded 98% in most conditions. Performance remained consistent even with blade sizes outside conventional age-based recommendations. Between-blade differences in intubation time were small, and complication rates were low across conditions. The Macintosh 2 blade performed comparably across all manikin sizes, with similar intubation times, high success rates, and favorable ease ratings. CONCLUSIONS: Intubation performance in pediatric manikin models was similar across a wide range of blade sizes. These hypothesis-generating findings warrant prospective clinical evaluation of simplified blade selection strategies for pediatric intubation.
Although telephone calls comprise almost one fourth of all childhood patient-physician contacts, the content of telephone care is not emphasized in most educational and service programs. In response to the need to improve management of telephone calls to our pediatric emergency room, we developed 28 protocols to deal with the 25 most common complaints presented by phone. This paper describes the content of these protocols, the training of the health assistants who administered them, and the measures we took to assure their safety and general utility in pediatric practice settings. The study demonstrates the feasibility of an organized system for telephone care based on protocols which include: (1) basic data to be collected for each chief complaint category; (2) a range of appropriate dispositions; and (3) advice for home management when the patient does not require an immediate medical visit. Potential uses of these protocols for medical and nursing education and for clinical service needs are discussed.
The authors report 98 cases of cardiac arrhythmia observed in the course of 2,500 pediatric anesthesias performed with constant electrocardiographic monitoring. The patients, aged 0 to 18 years, were in most cases healthy. Anesthesia was performed by different techniques for both surgical and non-surgical interventions for a variety of conditions, both serious and routine. Other than 3 cases of cardiac arrest (1 death) cardiac arrhythmias usually followed a benign course without hemodynamic repercussions. The authors emphasize the value of early detection of cardiac arrhythmias as well as vigorous treatment of predisposing conditions such as inadequate ventilation, acidosis and pain. The absence of correlation between the degree of rick, as estimated preoperatively (related to patient or procedure risk factors), and the frequency of occurrence seems to point to the value of more widespread use of ECG monitoring of pediatric patients undergoing anesthesia.
The findings reported in this article are based on a nationwide survey of the attitudes and practices of pediatric surgeons and pediatricians with respect to some of the difficult ethical choices confronting them in medical practice. Four hundred fifty-seven physicians completed a questionnaire in the spring of 1975 in which they reacted to a wide range of issues that have been of increasing concern to the public, as well as to the medical profession. The survey attempts to identify some areas of physician consensus as well as some of the factors, personal and professional, influencing physicians' attitudes. The survey and its statistical analysis are intended to provide current sociological data and are not intended by the authors as an endorsement of any particular point of view or course of action.
Circulation of pediatric journals through the main twenty international index on medical bibliography is analized.
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1. Full-term newborn infants should be breastfed, except if there are specific contraindications or when breast-feeding is unsuccessful. 2. Education about breast-feeding should be provided in schools for all children, and better education about breast-feeding and infant nutrition should be provided in the curriculum of physicians and nurses. Information about breast-feeding should also be presented in public communications media. 3. Prenatal instruction should include both theoretical and practical information about breast-feeding. 4. Attitudes and practices in prenatal clinics and in maternity wards should encourage a climate which favors breast-feeding. The staff should include nurses and other personnel who are not only favorably disposed toward breast-feeding but also knowledgeable and skilled in the art. 5. Consultation between maternity services and agencies committed to breast-feeding should be strengthened. 6. Studies should be conducted on the feasibility of breast-feeding infants at day nurseries adjacent to places of work subsequent to an appropriate leave of absence following the birth of an infant.