17.4 Childs Airway

Question 1

a) List the normal anatomical features of young children (<3 years old) which may adversely affect
upper airway management. (35%)

b) Which airway problems may occur due to these anatomical features? (30%)

c) Outline how these problems are overcome in clinical practice. (35%)

Answer 1

Anatomical feature Problem Overcome by
1. Large head with
prominent occiput.
Tendency to flex neck.
Neutral position with
e.g. folded towel under body.

2. Large tongue, pliant submental tissues.
   Obstruction of airway by digital pressure.
   Ensure fingers applied to bony surfaces.

3.*
Absence of teeth.
Difficulty maintaining face mask ventilation.
Use of appropriately sized guedel.

4.*
Long U shaped epiglottis, anterior larynx.
Difficulty with laryngoscopy,
epiglottis flopping into visual field.
Straight blade.

5. Narrow trachea.
   Flow proportional to radius to the power of 4.
   Small difference in radius due to trauma
   or oedema makes substantial difference to flow.
   Careful handling of airway,
   select tube size carefully,
   minimise need for changes.
6. Airway narrowest at level of cricoid, not vocal
   cords.
   Cricoid is a complete ring of
   non-compliant cartilage so
   pressure of tube may cause damage.
   With uncuffed tubes, a leak
   should be ascertained.
   High volume, low pressure
   cuffed tubes
   (half a size smaller than uncuffed)
   are now used routinely except in neonates.
7. Short trachea.
   Risk of endobronchial intubation.
   Auscultate chest, vigilance.