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Early diagnosis of airway closure from pigtail signature capnogram and its management in intubated small infants undergoing general anaesthesia for surgery

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Author(s): Mishra Sanghamitra

Journal: Indian Journal of Anaesthesia
ISSN 0019-5049

Volume: 54;
Issue: 4;
Start page: 331;
Date: 2010;
Original page

Keywords: Airway closure | continuous positive airway pressure end tidal carbon dioxide | glottic closure | positive end expiratory pressure | pigtail capnogram | hypercarbia | hypoxaemia

ABSTRACT
Spontaneous glottis closure during expiration in infants is a normal protective reflex that helps prevent alveolar and small airway collapse (due to compliant chest wall) and thereby maintains functional residual capacity. Endotracheal intubation eliminates this protective mechanism and puts the infant into the risk of hypoxaemia and hypercarbia. This report sums up the early detection of airway closure in a series of three intubated small infants undergoing surgery with general anaesthesia, by the appearance of typical pigtail shaped capnogram, associated with decreased end tidal carbon dioxide and mild hypoxaemia, which was successfully managed by early institution of positive end expiratory pressure.
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