Epiglottitis

Question 1

What pathogen is responsible for the development of

epiglottitis?

Answer 1

Haemophilus influenzae type B
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 1364.

Question 2

What are the typical presenting signs in a patient

with epiglottitis?

Answer 2

The most common presenting signs include sudden onset of
fever, dysphagia, drooling, voice changes, and a preference for
a seated position with the chest leaned forward and the head
extended. If obstruction has developed, retractions and labored
breathing may be present.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 1364

Question 3

What age-group is most affected by epiglottitis?

Answer 3

Ages 2-7 are the most commonly affected, although the relative
incidence has increased in the adult population as routine
Haemophilus vaccination has decreased the incidence in the
pediatric population.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 615.

Question 4

In addition to clinical symptoms, what is one method
of confirming a diagnosis of epiglottitis without
manipulating the airway?

Answer 4

A radiograph of the soft tissue of the neck may reveal the
thickened aryepiglottic folds and swelling of the epiglottis.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 1365.

Question 5

What precautions should be made in the evaluation

of a patient with epiglottitis?

Answer 5

Because agitation and struggling can result in the dynamic
collapse of the airway with subsequent total airway obstruction,
care should be taken to keep the patient calm and relaxed.
Excessive manipulation of the patient should be avoided and
absolutely no attempt to evaluate the airway should be made in
the unanesthetized patient.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 1365.

Question 6

What is the accepted induction and intubation

technique for a pediatric patient with epiglottitis?

Answer 6

Inhalation induction with the child in the sitting position is
acceptable. After the child becomes drowsy, he/she is placed
supine and mask ventilated while intravenous access is
acquired. Intubation is then performed with a styletted tube
using an endotracheal tube that is 1/2 size smaller than normal.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 614-615.