Pediatric Airway Flashcards
What are the salient anatomic differences between the pediatric and adult airway? Name 5.
1) Large tongue occupies relatively larger portion of the oral cavity
2) Proportionately larger epiglottis
3) Tracheal opening is higher
- C1 in infancy, C3/4 at age 7, C5/6 in the adult
- High anterior airway position of the glottic opening compare with adults
4) Cricoid ring is functionally the narrowest portion of the trachea as compared with the vocal cords in the adult
- uncuffed tubes provide adequate seal because they fit snugly at the level of the cricoid ring
5) Large occiput may cause flexion of the airway
- The larger occiput actually elevates the head into the sniffing position in most infants and children
- A towel may be required under the shoulders to elevate the torso relative to head in small infants
What are the salient physiologic differences between children and adults that affect airway management?
1) Higher basal oxygen consumption
2) Smaller functional residual capacity to body weight ratio
These factors result in more rapid desaturation in children compared with adults
What is functional residual capacity (FRC)?
Functional Residual Capacity (FRC) is the volume of air present in the lungs at the end of passive expiration.
Which pediatric patients should receive atropine pretreatment prior to laryngoscopy?
Controversial
UTD: “Although atropine is not routinely recommended for pretreatment prior to endotracheal intubation, we frequently use it for pretreatment during RSI for infants younger than one year of age because of their predilection for vagally induced bradycardia.”
What is the dose of atropine for pretreatment?
0.02 mg/kg
What is the preferred induction agent for pediatric intubation?
Etomidate
Exception = septic shock, when ketamine is preferred
What is the induction dose of etomidate in pediatric patients?
0.3 mg/kg IV
What is the induction dose of ketamine in pediatric patients?
2 mg/kg IV
What is the dose of SCh in pediatric patients?
For children <2y: 2 mg/kg IV
For children >2y, adolescents, and adults: 1.5 mg/kg IV
What is the dose of rocuronium in children?
1 mg/kg
Dosing for rocuronium is based upon ideal body weight, which is not an issue in most children
What is the formula for sizing a pediatric endotracheal tube for both cuffed and uncuffed tubes?
Uncuffed:
(Age/4) + 4
Cuffed:
(Age/4) + 3.5
Which pediatric patients should receive an uncuffed tube? A cuffed tube?
Use an uncuffed tube in neonates
For all others use of a cuffed tube is safe, effective, and preferred as per UTD
How do you know how far to insert the endotracheal tube in children?
Use Pedistat or the Broselow tape
Before inserting the tube place a piece of tape at the appropriate lip-to-tip centimetre line
When performing DL, when should you use a straight blade? Curved blade?
General rule:
Children <2 use a straight blade
Children >2 use a curved blade
Describe patient positioning for pediatric intubation.
In adults you are typically placing a pillow behind the head to flex the head on the torso (lower neck flexion). The head is then extended on the atlanto-occipital joint.
In small infants, elevation of the shoulders with a towel may be needed to counteract the effect of the large occiput that causes the head to flex forward on the chest.
As a general rule, once correctly positioned, the external auditory canal should lie just anterior to the shoulders.
