Pediatric syndromes and Airways

Question 1

Normal Peds Airway =

Answer 1

Larger heads proportionately
Larger tongue proportionately
Narrow nasal passages – obligate nasal breathers until around 5 months of age
Anterior and cephalad larynx
C4 in infants vs C6 in adults

Question 2

What to do if ETT does not advance past vocal cords easily?

Answer 2

DOWNSIZE ETT

Question 3

Peds respiratory physiology

Answer 3

-reduced lung compliance
-small and limited number of alveoli
-increased chest wall compliance
-cartilaginous rib cage
-weak intercostal and diaphragm muscles

Question 4

Peds have _____ number of type __ fibers. The adult has ____ compared to _____ of full term infants.

Answer 4

type 1 fibers
55%, 25%

Question 5

During apnea PaCO2 will rise ___mmHg during the first minutes and then __-__mmHg each minute after.

Answer 5

6mmHg
3-4 mmHg

Question 6

O2 consumption: peds vs adults

Answer 6

adults- 3ml/kg/min
peds- 6 ml/kg/min

Question 7

Vital capacity: peds vs adults

Answer 7

peds- 35 ml/kg
adults- 70 ml/kg

Question 8

Pierre Robinson sequence =

Answer 8

mandibular hypoplasia

Question 9

Syndrome: nasal obstruction and maxillary hypoplasia, obstruction if mouth is closed but mandible is normal so intubation is okay

Answer 9

Apert syndrome

Question 10

Craniofacial abnormalities:

Answer 10

Synostosis
Clefting
Hypoplasia

Question 11

Pierre Robinson intubation

Answer 11

FIBEROPTIC INTUBATON W/ SPONTEOUS BREATHING. INHALATION INDUCTION. AWAKE IV. (IF repaired then you are good)

Question 12

Treacher-Collins syndrome difficulties

Answer 12

Mask ventilation and tracheal intubation are very difficult

Intubation may be impossible if TMJ abnormalities

Question 13

Treacher Collins technique for intubation:

Answer 13

keep patient spontaneously breathing

Sedated fiberoptic intubation

LMA –> FOI
Tracheostomy