Dr. Borland and CHP Anesthesiology Faculty at the Sixth International Symposium on the Pediatric Airway
The International Symposium on the Pediatric Airway (ISPA), founded by Dr. Lawrence Borland of Children’s Hospital of Pittsburgh of UPMC (CHP), has been held approximately every four years since 1987. It has attracted participants from the U.S., Canada, Europe, and South America and has become one of the premier and unique venues for the interdisciplinary exchange of up to date information and new ideas about the airways of infants and children. In addition to pediatric anesthesiologists, participants include experts in specialties including pediatric otolaryngology, surgery, critical care medicine, pulmonology, neonatology, and radiology. Dr. Borland nearly single-handedly organized the past five events, which were held in Pittsburgh three times, as well as in Washington DC and Orlando. For the first time, Children's Hospital Colorado (formerly Denver Children's) hosted this year’s ISPA at its new hospital and conference center on the University of Colorado campus.
The three-day symposium was held on June 17-19, 2011 and featured lectures, panel discussions, abstract presentations, and airway workshops. The meeting attracted nearly 100 attendees from 17 states in the U.S. and from eight other countries in Europe, Canada, Latin America and South Africa. Dr. Borland co-chaired, moderated, and lectured at the conference. Other CHP participants included Drs. James Cain, Neal Campbell, Etsuro Motoyama, (a founding member of ISPA), as well as otolaryngologists Drs. Joseph Dohar and Robert Yellon, all of whom gave CHP and the Department of Anesthesiology a high visibility at this reputable international symposium.
Friday morning’s topics focused on updates on the developmental anatomy and physiology of the upper airway and imaging. Dr. Scott Markowitz from the University of Colorado’s presentation on the reappraisal of the shape of the pediatric larynx, as proposed in a recent editorial (EK Motoyama, Anes Analg, 2009), was of particular interest. The pediatric larynx is more cylindrical as it is in adults, rather than cone-shaped as has been assumed for half a century, and the narrowest opening at the cricoid is more oval than circular. These findings give anatomical evidence to support the recent trend of using cuffed rather than uncuffed endotracheal tubes in infants and young children, especially with the recent development of advanced large volume, low-pressure microcuffs, as presented by Dr. Andreas Gerber from Switzerland. The afternoon session focused on updates in airway pathology and management, including cystic fibrosis, asthma, laryngotracheomalacia, and laryngotracheal reconstruction.
The Saturday morning session provided updates in perioperative clinical techniques and airway management, including laryngospasm, mandibular hypoplasia, mechanism of upper airway collapse, and pharyngeal airway opening maneuvers. In the afternoon, Dr. Cain reviewed the clinical pharmacology and clinical applications of dexmedetomidine and Dr. Mohamed Mahmoud from Cincinnati Children’s Hospital Medical Center spoke on its different effects on airway configuration as compared to those of propofol. Drs. Borland and Dohar presented the new and exciting technology of videostroboscopy on awake children using the minimal anesthesia technique as recently published by Dr. Borland. The afternoon session included a panel discussion on airway management outside the OR as well as abstract presentations.
Dr. Borland chaired the Sunday session, which focused on obstructive sleep apnea and critical evaluation with polysomnograph as a preoperative evaluation of upper airway patency. Dr. Borland also presented the clinical management of difficult airways with trisomy 21 and Dr. Geoffrey Lane, the conference co-chair from the University of Colorado, concluded the symposium with a presentation on teaching and evaluating airway skills.
Overall, the symposium, originally started by Dr. Borland at CHP nearly a quarter century ago, was very successful. Children's Hospital Colorado will organize the next ISPA in three to four years.