Peds Airway Flashcards
peds vs adult airway
larger tongue
smaller pharynx
larger/floppy epiglottis
larynx anterior
where is peds airway narrowest?
at cricoid!!
difference in trachea in peds pts?
more narrow and less rigid
difference in peds tongue
Proportionately larger than adult = increased risk of obstruction. Also more difficult to move with laryngoscope
peds laryngeal position?
C3-4 (Adult: C4- C5)
why must we use straight blade in peds?
more acute angle to visualize glottic opening
epiglottis difference in peds?
Narrow, Ω shaped, angled away from axis of the trachea
[adults flat, parallel, broad]
vocal chords in peds?
more caudad on anterior, results in more difficult intubation
most narrow part of infant airway
cricoid cartilage or area immediately below
what can be the result cricoid ring being nonexpandable?
Tight ETT = edema = reduced luminal diameter = increased airway resistance and post-extubation croup
2 things to remember about cricoid ring?
nonexpandable and elliptical
Infant tracheal diameter
4mm (adults is 8)
1 mm of circumferential edema =
75% cross sectional decrease in the infant - 44% decrease in the adult
when does peds airway reach adult proportions?
10-12 yrs
Infants: Obligate nasal breathers, nasal obstruction can cause?
hypoxia
when do peds have adequate mouth breathing
3-5 months
why are peds More likely to have airway become distended or obstructed
↑ compliance of larynx, trachea, bronchi
Loss of spontaneous ventilation (GA) and vigorous crying causes
dynamic airway collapse
how do peds compensate for 2x O2 consumption of adults
increased RR
Obstruction during Anesthesia mostly caused by
loss of airway muscle tone
how to treat obstruction with anesthesia
continuous positive airway pressure (CPAP)
chin lift & jaw thrust
lateral position
Most effective overall: Jaw thrust
Upper respiratory infection (URI) can cause
↑ risk of laryngospasm, bronchospasm, edema
signs of big adenoids, tonsils, OSA
snoring, noisy breathing
sign of subglottic stenosis, foreign body.
croupy cough
Inspiratory stridor can be
laryngomalacia, laryngeal web, foreign body.
can be vocal cord palsy, papillomas
hoarseness
Wheezing can be d/t
asthma, bronchitis, foreign body.
when should intubation not be delayed
for diagnostics when severe hypoxia present
use a straight blade until…
2 years of age
historically what type of tubes were used on children
only uncuffed up until 8 yrs
Biggest risk factors of post-extubation laryngeal edema
Poorly fitted uncuffed ETTs
Repeat laryngoscopy
Uncuffed: If no air leak heard at 20-25 cm H2O, ETT should be changed to
next half size smaller.
minimal seal of cuffed tube?
20
difference in microcuff and regular cuff ETT
Tracheal sealing at lower pressure (<15 cm H2O)
shortened, more distal cuff
no murphy eye
disadvantages microcuff
expensive
can kink easily when warm
how much size does cuff account for
.5 - thats why larger uncuffed can be used
when can you start using cuffed ETT
3 kg!!
what size cuffed tube should you use
: Use ½ size smaller than uncuffed size. Inflate to minimal seal at ≤ 20 cm H2O
if you use nitrous during case with cuffed tube what precautions should you take
measure pressure every 10-15 mins for 2 hrs
Approximate ETT Size <500 g
2.0 uncuffed
Approximate ETT Size 500-1000gm
2.5 uncuffed
Approximate ETT Size 1000-2500 gm
3.0 cuffed or uncuffed
Approximate ETT Size term NB to 6 mo
3.0 cuffed
Approximate ETT Size 6 mo - 1 year
3.5 cuffed
Approximate ETT Size 1 yr - 18 months
4.0 cuffed
Approximate ETT Size 18 mo - 2 years
4-4.5 cuffed
> 2 years formula for ETT size
age/4 + 3.5
how to treat Post-extubation laryngeal edema/croup
Treat with steroids, nebulized racemic epinephrine, humidity
90% of subglottic stenosis is caused by`
prolonged intubation or poorly fitted cuffed or uncuffed ETT
Insertion Distance <1 kg
6 cm
Insertion Distance <2 kg
9 cm
Insertion Distance full term
10 cm
Insertion Distance 1 yr
11 cm
Insertion Distance 2 YR
12 cm
Insertion Distance formula
age/2 + 12
Peak inspiratory pressure must stay low to avoid what with lma use
abdominal insufflation/regurgitation.
what is lma sizing based on
weight
when should you give relaxant to peds?
when airway confirmed
