Paediatric Airways

1
Paediatric Airways
2
Upper Airway Anatomy

• Large head
• Large tongue
• High anterior larynx
• Infant epiglottis long, floppy U shaped
• Funnel shaped larynx
• Narrow trachea

3
Airway Differences
4

5
(No Transcript)
6
(No Transcript)
7
Respiratory Physiology

• Not mature until 8 years
• Deadspace volume very small
• Higher airflow resistance
• Higher chest wall compliance
• Higher ventilation-perfusion mismatch
• Higher oxygen consumption for weight
• Infant diaphragms lack slow muscle fibres
• Decreased respiratory reserve

8

• Area difference 12 fold prior to pathology
• Flow difference 120 fold prior to pathology
• Flow ? r 4 400 fold following pathology

9
Down Syndrome

• Relatively large tongue
• Small mandible
• Possible Cx spine instability
• OSA is common
• Possibly smaller ETT
• Difficult intubation

10
Pierre Robin Syndrome

11
URTI

• Bronchospasm
• Mucous plugging
• ? Early pneumonia
• Laryngospasm
• Stridor
• Cough

12
Tracheal Intubation

• Airway protection
• Facilitates access to shared airway
• Muscle relaxation
• Improve efficiency of ventilation
• Long procedures

13
ETT

• Diameter
• Oral ETT age/4 4
• Neonate 3.0-3.5mm
• Nasal under 6 years same, over 6 years half to
  one size smaller
• Length
• Oral ETT age/2 12
• Nasal ETT age/2 15

14
Cuffed ETT ?

• Postintubation croup?
• Recent studies little difference
• 2-3 cuffed or uncuffed post surgery
• 15 cuffed or uncuffed post PICU
• Less need to replace tube
• Better airway protection ? relevance
• No gas leak good for staff and IPPV
• Smaller diameter tube higher resistance

15
LMA

• As a face mask alternative
• Not with potential full stomach
• Possible for some dental/ENT work with minimal
  expected soiling
• Anaesthetist preference

16
Face Masks
17
Laryngeal Spasm

• Avoid
• CPAP Oxygen
• Clear airway judiciously
• Deepen anaesthesia
• Topical lignocaine
• Very low dose Sux (¼ usual)
• Intubate/reintubate if needed

18
Difficult Intubation

• AVOID
• Refer to tertiary centre if possible
• Spontaneous ventilation gas induction
• Then???

19

• Shikani