Pediatric difficult airway lecture Flashcards
Obligate nose breathers until when
5 months
Describe the larynx
anterior and cephalad, c4 (c6 in adults)
Describe airway
large epiglottis
Short trachea and neck
Large tongue
small pharynx
parynx is more anterior
Narrowest portion of airway
Glottis, although cricoid ring is the narrowest fixed
Type 1 muscle fiber in the pediatric lung
small number, only 25% compared to 55% in the adult
02 consumption vs adults
peds- 6ml/kg/min
adults- 3ml/kg/min
SAME for co2
What abnormality causes mandibular hypoplasia
pierre robin
APEX: Please Get That Chin
intubation considerations for hypoplasia mandible
nasal intubation
fiber optic
someone available to trach
apert disease might also be associated with ___
cardiac and renal problems
How will patients with cleft lip eat
bilat cleft lip will need a g tube
cleft palate / lift is associated with ___
congenital heart disease in 50%
trisomy 21 is associated with
“cardiac” (what rachel said in lecture)
Apex: most common cardiac defect is AV septal defect, then VSD
Bradycardia is common during sevo inductions, treat with anticholinergic
When are lips and palates fixed
lips-3 months
palate- 6 months
APEX says lip at 1 month, palate at 1 year
pierre robin intubation consideratinos
keep spontaneous breathing!
no muscle relaxers wit tracheal intubation
how to manage clefts
minimize narcotics
non respiratory depressants
LA
monitor overnight
cleft lip vs palate considerations
lip no problems
palate - possible obstruciton
Advantages of regional anesthesia
reduced concentrations of inhaled agents- decreased post op sedation, faster awakening
reduced use of opioids- decrease n/v, itching, post op sedation
improved gi functinos
reduced thromboembolic events
contraindications of neuraxial blocks
coagulopathy
severe infections
hydrocephalus
allergy to LA
chemo
lesions at sight of puncture
demylenatiing disease
refusal
previous spinal instrumentation
How to manage the fact that pedis cant tell you about the block to assess accuracy
use a test dose
When to use CHG vs iodine
iodine only if <2 months, wash it off when done, let it dry before inserting needle
conus medularis and dural sac in peds
L3
s3
L1/s1 in adults
contraindications to caudal anesthesia
pilonidal cyst
abnormal superficial landmarks
myelomeningocele pts
hydrocephalus/ intracranial hnt
neuropathy
parent non consent
caudal needle
blunt
tuohy
22g/20g angio cath
pt position of caudal anesthesia
lateral with legs and hips flexed- but keep an eye on airway
or
prone
for caudal anesthesia, the volume depends on ___ and the dose depends on ___
needed level of anesthesia
patients weight and concentration of the LA
Max volume and dose for caudal anesthesia
25 ml
3 mg/kg
volume for different levels of regional anesthesia
thoracic- 1.5ml/kg
lumbar- 1ml/kg
sacral- .5ml/kg
LA toxicity treatment
20% intralipid solution
bolus 1.5ml/kg x2 if needed
0.25ml/kg/min for 1 hour
Test dose
aspiration of blood (alone) is not reliable
0.1ml/kg of LA with epi 5mcg/ml added MAX dose 3ml
watch for hr increase of 10 bpm, bp increase of 15mmhg, t wave increase >25%, or bradycardia are all signs of IV injection
neurotoxicity signs
HA
somnolence
vertigo
parasthesia
tremors
shivering
convulsions
cardiac: dysrhtymias, wide qrs, block, torsades, vt, cv collapse
How to prevent risk of toxicity
avoid hypothermia, acidosis, hypercarbia, hyperkalemia
inject slowly
test dose
Conditions with large tongue
“Big Tongue”
beckwith
trisomy 21
conditions with small chins
“Please Get That Chin”
Pierre robin
Goldenhaar
Treacher collins
Cri du chat
Conditions with C spine anomalies
“Kids Try Gold”
Klippel fiel
Trisomy 21
Goldenhaar
Pierre robin syndrome
small mandible
big tongue
cleft palate
Treacher collins syndrome
small mandible/ mouth
choanal atresia
trisomy 21
small mouth large tongue
ao instability
small subglottic diameter
klippel fiel
neck rigidity
goldenhaar
c spine
small madnible
main issues for cleft lip or palate
airway- difficult laryngoscope, mask ventilation, aspiration
other- failure to thrive
