Paediatric Airway

Question 1

Why is the paediatric airway more difficult than the adult airway?

Answer 1

This question focuses on the subgroup causes of the difficulty.

1) Anatomical
2) Physiological
3) Psychological
4) Equipment

Question 2

What are the anatomical reasons why the paediatric airway is more difficult?

Answer 2

(1) Large head/occiput, (2) Large tongue, (3) Superior larynx + anterior cords, (4) Large adenoids and tonsils, (5) Small cricoid cartilage, (6) Large stomach, low GO sphincter tone, small lungs, (7) Horshoe-shaped floppy epiglottis, (8) Loose teeth

Question 3

What are the physiological reasons why the paediatric airway is more difficult?

Answer 3

Different HR/RR depending on age, less physiological reserve (smaller FRC), more prone to bradycardia esp with sux, risk of stiff chest with fentanyl

Question 4

What are different equipment issues that make paediatric airway more tricky?

Answer 4

Different ETT sizes +/- need for cuff, softer suction catheters, straight blades for <1 years, smaller bag, minimise dead space with ventilators/tubing, Magill’s for nasal ETT, needle cricothyroidotomy is a rescue technique in <12 years (no room for surgical airway)