Pediatric Airway
High larynx is more accurate than anterior larynx. Kids airways are very consistent,
but you need to know where to look. Kiddies are very difficult to preoxygenate Use straight blade in infants/small children No defasiculating meds in children <10, be very wary of using opoids in kids (they are usually sympathetically dependant when ill) Pretreatment mnemonic is LAD (lidocaine, atropine, ± defasiculating dose) for lads instead of LOAD Collar all peds when tubed, minor changes in neck position can cause extubation. Use commercial tube holders preferentially.
Upper Airway Obstruction
Should still be able to bag Nobody actually gets to do needle crics on kids, even the people who author articles may never have done it on a real kid. Use 14 g angiocath or better yet, non-bendable 12 g specifically made for this purpose. Put the needle anywhere (Pretend you are cannulating a vein) and use #3 ET connector. It will be very difficult to bag, this is normal. Or use 2.5 et adapter with infusion tubing. (AJEM Jan 2004) Partial obstruction=wait for back up Full Obstruction= Back blows/chest thrusts Look c McGill’s Push down mainstem with ET tube
Pediatric Airway Equipment
Dangerous Equipment
- 0 Straight blade is too short for term and older infants, only for preemies.
- #1 Curved blade is inappropriate for infants, straight blade much better
- 250 cc BVM, for newborns only
- Cuffed ETs below size 5.5 Occasionally useful for asthmatics, but should not be in emergency airway carts
- Large handle, too bulky for peds
Use cuffed tubes (Br J Anaesth 2009;103(6):867)
Dalal PG, Murray D, Messner AH, Feng A, McAllister J, Molter D. Pediatric laryngeal dimensions: an age-based analysis. Anesth Analg. 2009;108:(5)1475-9. PMID: 1937
These authors measured the cross sectional area of the airways of 153 children (6months to 13 years) using video bronchoscopy under general anesthesia, and they found that it is the glottis not the cricoid that is the narrowest portion of the airway.
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