Paediatric Airway Management

Question 1

What is the most likely cause of arrest in children?

Answer 1

• Cardiac arrest secondary to hypoxia

Question 2

List some key anatomical differences between adult and paed airways

Answer 2

Narrow nostrils

<6 mths obligatory nose breathers

Large tongue

Small face and mandible

Funnel shaped larynx

Large floppy epiglottis

Short and softer trachea

Smaller airway diameter

Poorly developed intercostal muscles

Question 3

List some key physiological differences between adult and paediatric patients

Answer 3

• Greater metabolic rate and O2 consumption
• Decreased lung reserves
• Smaller SA for GE
• Decreased glucose stores

Question 4

How do you position an infant (<12 months) for airway manoeuvres

Answer 4

• Neutral position
  –> place rolled towel under shoulders to account for large occiput

Question 5

How do you position a child (1-8 years) for airway manoeuvres / intubation

Answer 5

• Sniffing position (head tilt/chin lift)
  —> use jaw thrust if suspected c-spine

Question 6

What is the weight range for the neopuff?

Answer 6

Up to 10kg

Question 7

What drugs are used for intubating a paediatric patient?

Answer 7

• Atropine and suxamethonium in infants under 3 months!
  –> consider atropine in any infant under 12

(more likely to experience vagally-induced bradycardia from administration of paralytic agent)

Question 8

What laryngoscope blades are used in paediatric patients?

Answer 8

• Miller (straight) blade is used in children aged 3 and under to overcome large floppy epiglottis

Question 9

Why are uncuffed ETTs used in paediatric patients?

Answer 9

• Due to funnel shaped trachea, normal cuffed tubes apply high pressure to narrowest part of airway causing ischaemia and tissue necrosis

Question 10

How are ETTs secured in paediatric patients?

Answer 10

• Silk suture tie to mark ETT at documented length
• Elastoplast sports tape cut in trouser legs
• Reinforced by duoderm on cheeks

Question 11

Why are ETTs secured using tape in paediatric patients?

Answer 11

• Shorter trachea means less movement is required to dislodge

Question 12

What ventilator setting is preferred for paediatric patients with uncuffed ETTs?

Answer 12

PCSIMV+
- Operator can titrate pressure to compensate for leak around tube

Question 13

What ventilator setting is preferred for paediatric patients with cuffed ETTs?

Answer 13

VCSIMV+

Question 14

How should the ventilator circuit be set up for a paediatric patient <20kg?

Answer 14

• Hamilton T1 with neonatal software and neonatal circuit
• ensure neonatal CO2 line and appropriate filter

Question 15

How should the ventilator circuit be set up for a paediatric patient between 20-30kg?

Answer 15

• Hamilton T1 ventilator
• Adult tubing / sensors

! Do not use liquorice stick / elbow
(this adds extra dead space to circuit)

Question 16

How should ventilator circuit be set up for paediatric patient over 30kg

Answer 16

• Hamilton T1 ventilator
• Adult tubing / sensors

With elbow