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Anaesthesia Critical Care & Pain Medicine
Sous presse. Epreuves corrigées par l'auteur. Disponible en ligne depuis le mardi 19 mars 2019
Doi : 10.1016/j.accpm.2019.02.004
Management of the child's airway under anaesthesia: The French guidelines
 

Christophe Dadure a, , Nada Sabourdin b, Francis Veyckemans c, Florence Babre d, Nathalie Bourdaud e, Souhayl Dahmani f, Mathilde De Queiroz e, Jean-Michel Devys g, Marie-Claude Dubois g, Delphine Kern h, Anne Laffargue c, Marc Laffon i, Corinne Lejus-Bourdeau j, Karine Nouette-Gaulain k, l, Gilles Orliaguet m, Etienne Gayat n, Lionel Velly o, Nadège Salvi p, Chrystelle Sola a
a 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 
b Département d’anesthésiologie-réanimation hôpital Armand Trousseau, AP–HP, 26, avenue du Dr Arnold-Netter, 75012 Paris, France 
c Department of paediatric anaesthesia, Jeanne de Flandre hospital, university hospitals of Lille, 59037 Lille, France 
d Department of anaesthesia, Bergonié institute, 33000 Bordeaux, France 
e Département d’Anesthésiologie Réanimation Pédiatrique, Hôpital Femme Mère Enfant, 69677 Bron, France 
f 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 
g Service d’anesthésie-réanimation, fondation ophtalmologique Adolphe de Rothschild, 25, rue Manin, 75019 Paris, France 
h Departments of anaesthesia and intensive care, university hospital of Toulouse, place du Dr Baylac, TSA 40031, 31059 Toulouse cedex 9, France 
i Department of anesthesia and intensive care, university hospital and medical university François-Rabelais, Tours, France 
j Service d’anesthesie réanimation chirurgicale, Hôtel Dieu, Hôpital Mère Enfant, CHU de Nantes, 44093 Nantes cedex, France 
k Service d’anesthésie réanimation Pellegrin, hôpital Pellegrin, CHU de Bordeaux, place Amélie Raba Léon, 33000 Bordeaux, France 
l Université Bordeaux, Inserm U12-11, laboratoire de maladies rares: génétique et métabolisme (MRGM), 176, rue Léo-Saignat, 33000 Bordeaux, France 
m 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 
n Department of anesthesiology and Intensive care, Saint Louis, Lariboisière university hospital, université Paris Diderot, BioCANVAS, UMR-S 942, Inserm, 75010 Paris, France 
o 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 
p Department of anaesthesia and intensive care, assistance publique Hôpitaux de Paris, Necker-Enfants Malades Hospital, 75743 Paris, France 

Corresponding author at: Département d’anesthésiologie-réanimation Femme-Mère-Enfant, CHU de Lapeyronie, institut de génomique fonctionnelle, UMR 5203 CNRS – U 1191 Inserm, université de Montpellier, 34285 Montpellier cedex 5, France.Département d’anesthésiologie-réanimation Femme-Mère-Enfant, CHU de Lapeyronieinstitut de génomique fonctionnelle, UMR 5203 CNRS – U 1191 Inserm, université de MontpellierMontpellier cedex 534285France
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.

The full text of this article is available in PDF format.

Keywords : Airway, Management, Children, Guidelines



 These guidelines were written in collaboration with the French-speaking paediatric anaesthesiologists and intensivists (Association Des Anesthésistes Réanimateurs Pédiatriques d’Expression Francophone , ADARPEF )



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