{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T01:45:42Z","timestamp":1773279942880,"version":"3.50.1"},"reference-count":21,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2020,10,18]],"date-time":"2020-10-18T00:00:00Z","timestamp":1602979200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Anesthesia"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Perioperative respiratory adverse events account for a third of all perioperative cardiac arrests, with bronchospasm and laryngospasm being most common. Standard treatment for bronchospasm is administration of inhaled salbutamol, via pressurized metered dose inhaler. There is little evidence on the best method of attaching the pressurized metered dose inhaler to the artificial airway during general anesthesia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>The aim of this study is to investigate the best method to deliver aerosolized salbutamol via pressurized metered dose inhaler to the lungs of an anesthetized child.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We measured salbutamol delivered by pressurized metered dose inhaler through different sized tracheal tubes, supraglottic airway devices, and tracheostomies <jats:italic>in vitro<\/jats:italic> for methods commonly employed for connecting the pressurized metered dose inhaler to the artificial airway. Breathing was simulated for patients weighing 3, 16, 50, and 75\u00a0kg. Pressurized metered dose inhaler actuation coincided with inspiration.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A pressurized metered dose inhaler combined with an in\u2010line non\u2010valved or valved spacer, or the direct method, when delivered via tracheal tube, was linked with improved delivered dose of salbutamol, compared to all other methods for 3 or 50\u00a0kg simulated patients weights. The delivered dose when using a non\u2010valved spacer was greater than all methods for 16 and 75\u00a0kg patient weights. A spacer improved delivery for the flexible supraglottic airway device type, and there was no difference with or without a spacer for remaining types.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Via tracheal tube and non\u2010valved spacer, the following doses should be delivered after single actuation of a 100\u00a0\u00b5g labeled\u2010claim salbutamol dose: ~2\u00a0\u00b5g\u00a0kg<jats:sup>\u22121<\/jats:sup> per actuation to a 3\u00a0kg neonate, ~1\u00a0\u00b5g\u00a0kg<jats:sup>\u22121<\/jats:sup> per actuation to a 16\u00a0kg child, and\u00a0~\u00a00.5\u00a0\u00b5g\u00a0kg<jats:sup>\u22121<\/jats:sup> per actuation for a 50\u201375\u00a0kg child. The least effective methods were the syringe, and the uni\u2010 and bidirectional adaptor methods, which require replacement by the direct method if a spacer is unavailable.<\/jats:p><\/jats:sec>","DOI":"10.1111\/pan.14028","type":"journal-article","created":{"date-parts":[[2020,9,30]],"date-time":"2020-09-30T19:47:29Z","timestamp":1601495249000},"page":"1363-1377","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Assessment of different techniques for the administration of inhaled salbutamol in children breathing spontaneously via tracheal tubes, supraglottic airway devices, and tracheostomies"],"prefix":"10.1111","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7532-8372","authenticated-orcid":false,"given":"Natalie","family":"Anderson","sequence":"first","affiliation":[{"name":"University of Western Australia Perth Australia"},{"name":"Telethon Kids Institute Perth Australia"},{"name":"Perth 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