Negative pressure suction test: An intraoperative airway maneuver to assess effectiveness of surgical correction of tracheobronchomalacia

Background Surgical correction of tracheobronchomalacia (TBM) has evolved greatly over the past decade, with select pediatric institutions establishing dedicated surgery and anesthesia teams to navigate the complexities and challenges of surgical airway repairs. Although anesthetic techniques have e...

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Bibliographic Details
Published in:Pediatric anesthesia 2024-04, Vol.34 (4), p.289-292
Main Authors: Kuo, Frederick H., Elliott, Richard A., Watkins, Scott C., Shieh, Hester F., Smithers, Charles J., Jennings, Russell W., Munoz‐San Julian, Carlos
Format: Article
Language:English
Subjects:
Airway Extubation
Anesthesia
Anesthetics
bronchomalacia
bronchoscopy
Child
Humans
Pediatrics
Respiration
Suction
Suctioning
tracheobronchomalacia
Tracheobronchomalacia - surgery
tracheomalacia
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Summary:Background Surgical correction of tracheobronchomalacia (TBM) has evolved greatly over the past decade, with select pediatric institutions establishing dedicated surgery and anesthesia teams to navigate the complexities and challenges of surgical airway repairs. Although anesthetic techniques have evolved internally over many years to improve patient safety and outcomes, many of these methods remain undescribed in literature. Technique In this article, we describe the intraoperative negative pressure suction test. This simulates the negative pressure seen in awake and spontaneously breathing patients, including the higher pressures seen during coughing which induce airway collapse in patients with TBM. Also known as the Munoz maneuver in surgical literature, this test has been performed on over 300 patients since 2015. Discussion The negative pressure suction test allows for controlled intraoperative assessment of surgical airway repairs, replaces the need for risky intraoperative wake‐up tests, increases the chances of a successful surgical repair, and improves anesthetic management for emergence and extubation. We provide a guide on how to perform the test and videos demonstrating its efficacy in intraoperative airway evaluation. Conclusions As surgeries to repair TBM become more prevalent in other pediatric institutions, we believe that pediatric patients and anesthesia providers will benefit from the insights and methods described here.
ISSN:1155-5645
1460-9592
DOI:10.1111/pan.14822