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emmedonline
Dr. Ajith Kumar J MD
Dept. of Emergency Medicne
Travancore Medicity, Kollam
India
editor
MAJOR DIFFERENCE IN PEDIATRIC AIRWAY
Pediatric anatomy | Potential implication | Airway maneuver |
Large head & occiput | May push head forward and occlude airway | Shoulder roll may be required to align airway axes. |
Large tongue | May occlude upper airway in obutnded or paralyzed patient | Jaw thrust, oro ornasopharyngeal airway, miller blade may have to be used. |
Superior larynx and cords | Make visualisation of cords difficult | Shoulder roll may be required to align airway axes, straight laryngoscope to lift the epiglottis. |
Cricoid narrowing | Subglotiic space is narrowest portion of the pediatric airway, prone to inflammation and upper airway obstruction | Monitor cuff inflation pressure in small childrens. |
Large adenoids and tonsils | May cause upper airway obstruction; may bleed with nasal intubation | Avoid blind nasal intubation in young children. |
Small cricoid cartilage | Makes cricothyrotomy technically difficult. | Needle cricothyrotomy preferred in young children. |
Large stomach, low gastroesophageal sphincter tone, relatively small lungs | Insufflation of stomach with bag-valve mask ventilation or swallowed air can compromise respiratory status and prone for vomiting. | Consider early placement of orogastric or nasogastric tube to deflate stomach using positive ventilation in obtunded patient.
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Selection of ET tube
ET tube size = (16 +age in years)/4
OR
PALS
Uncuffed ET ID =4 + (age/4)
Cuffed ET tube ID = 3.5 + (age/4)
How to calculate the angle of mouth ?
Angle of mouth = Tube ID X 3.
Cuffed V/S Uncuffed Tube
Recently studies have shown that both cuffed and uncuffed tubes can be used in infants and children’s.
Cuffed tubes are preferred as it can prevent aspiration, avoid air leak.
But using cuffed ET tube close monitoring of the cuff pressure 20 -25 cmH2O is essential.
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emmedonline
Dr. Ajith Kumar J MD
Dept. of Emergency Medicne
Travancore Medicity, Kollam
India
editor