Croup-Epiglottitis Flashcards
What is the most important aspect of anesthesia care in the management in the difficult pediatric airway?
- Preoxygenation
What are the primary differences in croup in relation to stridor?
- Caused by turbulent flow
- High-pitched adventitious sound
- Biphasic (inspiratory and expiratory)
What are the three classifications of stridor?
- Biphasic
- Inspiratory
- Expiratory
What does biphasic stridor indicate?
- Lesion of the larynx or subglottis
- CROUP
What does inspiratory stridor indicate?
- Laryngeal or subglottic obstruction
- Laryngomalacia
- Vocal cord paresis
What does expiratory stridor indicate?
- Intrathoracic process
- Extrinsic tracheal compression
- Tracheomalacia
- Bronchotrachetis
What are the most common patient characteristics in Croup?
- Haemophilus parainfluenzae infection of the upper respiratory tract (Types 1, 2, 3)
- 1-3 years old, median age 18 months
- 2:1 prevalence in males
- S/S: (low fever, barking cough, hoarseness, dyspnea, exhaustion and hypoxia, self-limiting and benign, slow onset, rhinorrhea)
What is a typical feature seen in a CXR of the airway in the patient with croup?
- Steeple sign (narrowing of subglottic airway)
Describe the Westley Croup Score?
- Mild croup <2
- Moderate croup 3-7
- Severe croup >8
What are some important aspects of the medical management of Croup?
- 02 and cool humidity
- Racemic Epi (0.5 mL of 2.25% of 2.5 mL of NS) (avoid in children with glaucoma and ventricular outflow obstruction, aka Tetralogy of Fallot) REBOUND AIRWAY COMPROMISE AFTER EPI WEARS OFF
- Hydration
- Steroids (Symbicort, decadron)
Does Croup always require intubation?
- NOT USUALLY, depends on airway constriction
- Dry-out patient in case of emergency
Describe post-extubation Croup
- Occurs from inflammatory response created by extrinsic factors: ETT
- Luminal narrowing
- Poiseuille’s principle (16-fold increase in airway resistance with laminal narrowing)
What is the primary risk for Post-extubation Croup?
- CUFFED ETT UNDER PRESSURE
Describe the treatment of post-extubation croup?
- REDUCE AIRWAY CONSTRICTION
- HELIUM AND GAS MIXTURE
- REINTUBATION WITH 1/2 SIZE SMALLER
- AVOID TOPICAL LIDOCAINE (VASODILATION)
When does epiglottitis occur?
- ANY AGE
What is the usual cause of epiglottitis?
- Inflammation is secondary to an infectious process, normally H. influenzae. Can be viral.
- FAST ONSET OF SYMPTOMS
- Salivation, anxious, cyanosis, high fever, drooling
Describe the key features in the anesthetic management of the patient with epiglottitis
- SITTING POSITION FOR PREOXYGENATION, DON’T LIE PATIENT DOWN
- DIFFICULT AIRWAY EQUIPMENT AND CRICOTHYROIDOTOMY TRAY
- INTUBATE IN OR IF ETT INDICATED
- “THUMB SIGN” ON LATERAL CXR
- ANTIBIOTICS BEFORE EVERYTHING ELSE, INCLUDING 02!!!!!
- KETAMINE
- RSI NOT ALWAYS INDICATED
- AWAKE INTUBATION SHOULD BE AVOIDED
What is the cause of cleft palate?
- Defect in palatal growth
- More common in males
- Unilateral cleft lip, unilateral cleft lip, and palate, bilateral cleft lip, and palate, cleft palate alone
Describe the features of cleft palate
- More common in males
- Usually left-sided
- Large, cavernous defect
- cleft lip at 3 months
- Cleft palate at 6 months
- Associated w/ many syndromes (Pierre Robin, Treacher Collins, Downs Syndrome, Fetal Alcohol Syndrome)
What are the anesthesia considerations with a cleft palate patient?
- PREPARE FOR DIFFICULT AIRWAY (HAVE LMA AVAILABLE)
- INHALATION INDUCTION
- SEVOFLURANE
- 100% 02
- Difficult mask ventilation may require adjunct airways
- Oral RAE taped to chin
- PLACEMENT OF NASAL AIRWAY TO ENSURE PATENT AIRWAY
