Mod V: Pediatric Airway management Flashcards
Pediatric Airway management
Airway management can prove particularly challenging in the pediatric patient due to:
Physiological and anatomical issues
![](https://s3.amazonaws.com/brainscape-prod/system/cm/267/814/516/a_image_thumb.png?1550114320)
Physiologic Issues
Physiologic issues that make Airway management particularly challenging in the pediatric patient include:
Low FRC
High O2 consumption
High “alveolar/FRC” ratio
These all lead to RAPID DESATURATION!!!
Physiologic Issues
Why are infants and neonates dependent on HR for CO?
Noncompliant ventricles
Physiologic Issues
Which CV complication would Hypoxia lead to very quickly in peds?
CV collapse
Hypoxia => Bradycarddia => CV collapse
Physiologic Issues
Why is Airway patency “HIGHEST PRIORITY” in peds vs. adults?
Time from apnea to CV collapse is much shorter in peds vs. adults
Physiologic Issues
What dose of Atropine is often administered during induction in peds?
Atropine
Induction dose: 0.02 mg/kg
Physiologic Issues
Why is Atropine (0.02 mg/kg) often administered during induction in peds?
To preempt Bradycardia
Remember infants and neonates are dependent on HR for CO due to noncompliant ventricles
Also Hypoxia => Bradycarddia => CV collapse
Pediatric Airway Equipment
Preparation for airway management must be complete. What does it include?
Appropriate sized equipment…
must be immediately available
(Laryngoscopes, oral airways, LMA’s, ETT)
Several airways of each type…
should be prepared to allow quick adjustment should this be required
Pediatric Airway Equipment - Laryngoscopes
How do peds Laryngoscopes handle differ from adult’s ones?
Narrower
Less cumbersome
Lighter weight
More natural feel with smaller blade
You can put the smaller blade on the big handle, just feels akward!!!
![](https://s3.amazonaws.com/brainscape-prod/system/cm/267/925/393/a_image_thumb.jpg?1550202858)
Pediatric Airway Equipment - Laryngoscopes
Blades Assortment sizes:
0, 1, 2
Pediatric Airway Equipment - Laryngoscopes
Blades Styles:
MAC vs. Miller
Wis-Hippel or Robertshaw (Wide flange)
Engages tongue left - Facilitates ET passage
Pediatric Airway Equipment - Laryngoscopes
Curved Laryngoscope blade types. During laryngoscopy, the tip or beak of the blade is compressed into the angle formed by the base of the tongue and the epiglottis, indirectly raising the epiglottis:
Macintosh or Mac Blade
![](https://s3.amazonaws.com/brainscape-prod/system/cm/267/932/447/a_image_thumb.png?1550203492)
Pediatric Airway Equipment - Laryngoscopes
Straight laryngoscope blade is traditionally recommended for intubation in infants, due to the large size and flexibility of the infant epiglottis, since it allow to lift the epiglottis directly:
Miller Blade
![](https://s3.amazonaws.com/brainscape-prod/system/cm/267/932/511/a_image_thumb.png?1550203547)
Pediatric Airway Equipment - Laryngoscopes
Straight blade with a wider flange more like the Mac blade; this blade is also known as:
Wis Hipple Blades
![](https://s3.amazonaws.com/brainscape-prod/system/cm/267/932/551/a_image_thumb.png?1550203622)
Pediatric Airway Equipment - Laryngoscopes
Blade designed for neonatal and infant use, this blade features a wide flange and a gentle shallow curvature of the blade to lift the epiglottis indirectly in a similar way to the Macintosh blades
Robertshaw Blade
![](https://s3.amazonaws.com/brainscape-prod/system/cm/267/932/631/a_image_thumb.png?1550203832)
Pediatric Airway Equipment - Laryngoscopes
Recommended Mac Blade size for Ages 1-2 y/o
MAC 1
(9 cm)
![](https://s3.amazonaws.com/brainscape-prod/system/cm/267/932/639/a_image_thumb.jpeg?1551137696)
Pediatric Airway Equipment - Laryngoscopes
Recommended Mac Blade for Ages 3-5 y/o
MAC 2
(11cm)
![](https://s3.amazonaws.com/brainscape-prod/system/cm/267/932/695/a_image_thumb.jpeg?1551137747)
Pediatric Airway Equipment - Laryngoscopes
Recommended Miller Blade size for Neonate/Infant:
Miller 0
![](https://s3.amazonaws.com/brainscape-prod/system/cm/267/932/704/a_image_thumb.jpg?1551141523)
Pediatric Airway Equipment - Laryngoscopes
Recommended Miller Blade size for Ages 1-2 y/o:
Miller 1
![](https://s3.amazonaws.com/brainscape-prod/system/cm/267/932/719/a_image_thumb.jpg?1551141600)
Pediatric Airway Equipment - Laryngoscopes
Recommended Miller Blade size for Ages 2-6 y/o:
Miller 2
![](https://s3.amazonaws.com/brainscape-prod/system/cm/267/932/736/a_image_thumb.jpg?1551141635)
Pediatric Airway Equipment - Laryngoscopes
Recommended Wis-Hippel Blade size for Ages 1-2 y/o:
Wis-Hipple 1
![](https://s3.amazonaws.com/brainscape-prod/system/cm/267/932/746/a_image_thumb.jpg?1551141746)
Pediatric Airway Equipment - Laryngoscopes
Recommended Wis-Hippel Blade size for Ages 3-4 y/o:
Wis-Hipple 1.5
![](https://s3.amazonaws.com/brainscape-prod/system/cm/267/932/800/a_image_thumb.jpg?1551141790)
Pediatric Airway Equipment - Laryngoscopes
Recommended Mac Blade size for Ages > 8 y/o
MAC 3
![](https://s3.amazonaws.com/brainscape-prod/system/cm/267/932/833/a_image_thumb.jpg?1551141877)
Pediatric Airway Equipment - Laryngoscopes
Recommended Miller Blade size for Ages > 8 y/o:
Miller 2-3
![](https://s3.amazonaws.com/brainscape-prod/system/cm/267/932/982/a_image_thumb.jpg?1551141960)
Pediatric Airway Equipment - Laryngoscopes
Recommended blade (curve vs straight) for < 2 y/o
Straight
(Recommended for < 2 y/o)
Pediatric Airway Equipment - Laryngoscopes
Recommended blade (curve vs straight) for > 5 y/o
Curved
(Recommended for > 5 y/o)
Pediatric Airway Equipment - Endotracheal Tubes
ET tube size for Preterm (< 1000g):
2.5 mm
![](https://s3.amazonaws.com/brainscape-prod/system/cm/267/933/145/a_image_thumb.jpg?1551142187)
Pediatric Airway Equipment - Endotracheal Tubes
ET tube size for Preterm (> 1000 gm)
3.0 mm
![](https://s3.amazonaws.com/brainscape-prod/system/cm/267/933/284/a_image_thumb.jpg?1551142218)