Josef Holzki

University Children´s Hospital Liege (Belgium), Germany

Presentation Title:

Modern insights on pediatric cuffed endotracheal intubation

Abstract

Eckenhoff described in 1951 the pediatric larynx according to the anatomical findings by Bayeux (1897) and Peter (1936) adding to his own observations of the widely distensible vocal cords when intubating children without muscular paralysis. The Cricoid Outlet (CO) is definitely the narrowest, non-distensible part of the pediatric larynx till the 8th year of life. Eckenhoff´s findings are valid till today as can be seen in every professional airway endoscopy. These data were confirmed by the pediatric ENT-surgeon Fayoux et al in 2006 in a large autopsy study including premature infants. However, pediatric anesthesiologists paid little attention to these pivotal findings but used cuff less tracheal tubes for this age group, encountering injuries rarely and mostly the same location, the CO.

In 2003, Litman et al presented axial transections of larynges of infants till 14 years old children by Magnetic Resonance Imaging (MRI). They alleged that the CO has an oval structure and therefore cuffed intubation supposedly is always indicated in pediatric intubation. This proved to be wrong because MRI cannot depict cartilages, only well perfused mucosa which appears to be oval at the entrance of the distal larynx, slanting toward the circular, rigid CO, showing that Litman´s et al transections were too high above the cartilaginous CO.

After endless discussions about the value of cuffed/cuffless intubation with results of very low-quality evidence (Cochrane Review) it took many years till 2021 when Isa et al finished an autopsy study with fresh specimens, showing what particularly the larynx of infants really has been since 1897:

Ratio 30 children	0.98 (circular) Measurem	Calibrations	Glottic length
Ratio 19 infants	1.00 (circular) 5.1/5,1 mm	4.9 mm	7.10 mm
Ratio 5 toddlers	1.01(circular) 6.4/6.3 mm	6.3 mm	10.05 mm
Ratio 6 4-10 yrs	0.95 (near circ.) 9.1 mm	7.9 mm	12.72 mm

Biography

Josef Holzki is a distinguished anesthesiologist with extensive experience in pediatric anesthesia, intensive care, and airway management. He became a board-certified anesthesiologist in 1973 in Germany and soon after served as Chief of Pediatric Anesthesia and Surgical Intensive Care at the Children’s Hospital in Trier from 1974 to 1983. From 1983 to 2006, he continued his dedicated service at the Pediatric Children’s Hospital in Cologne, Germany, where he specialized in pediatric anesthesia, intensive care, and pediatric airway endoscopy. Throughout his career, he has shared his expertise globally, conducting teaching sessions in more than 30 countries. From 2010 to 2021, he served as a Teaching Professor of Pediatrics at the University Hospital of Liège in Belgium, contributing significantly to medical education and pediatric care before retiring in 2021. He has published over 50 international papers and remains recognized for his contributions to advancing pediatric anesthesia and airway management practices worldwide.

5th International Conference on Otorhinolaryngology

Josef Holzki

Presentation Title:

Modern insights on pediatric cuffed endotracheal intubation

Abstract

Biography

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