Peds week 3

Question 1

Normal Pediatric Airway

Answer 1

Larger heads proportionately
Larger tongue proportionately
Narrow nasal passages – obligate nasal breathers until around 5 months of age (they can suffocate if the nares are blocked)

Anterior and cephalad larynx

C4 in infants vs C6 in adults

Question 2

More Normal Pediatric Airway

Answer 2

Large epiglottis
Short trachea and neck
Prominent adenoids and tonsils

According to Dr. Motoyama’s article in 2009, the glottis is the narrowest point in the child as in the adult.

The rigid cricoid ring is functionally the narrowest portion of the larynx

Question 3

Pediatric Physiology

Answer 3

reduced lung compliance

small and limited number of alveoli

increased chest wall compliance

cartilaginous ribcage

weak intercostal and diaphragmatic musculature

Question 4

Peds have a smaller number of type ___ fibers

Answer 4

small number of type 1 fibers

adult has 55% compared to 25% in full term infants

Promotes chest wall collapse during inspiration and low residual lung volumes at expiration

Question 5

Peds have a ____ rate of o2 consumption

Answer 5

higher

Question 6

Peds are prone to ______ and ________ when apneic

Answer 6

Prone to atelectasis and hypoxemia when apneic

Question 7

Peds _____ and _____ respiratory drives are not well developed

Answer 7

Hypercapnic and hypoxic respiratory drives not well developed

Question 8

During apnea, PAC02 will rise __mmHg during the first minutes and then ____mmHg each minute after

Answer 8

During apnea, PAC02 will rise 6mmHg during the first minutes and then 3-4mmHg each minute after

Question 9

HIGHER rate of o2 consumption compared to adults. ___ml/kg/min compared to adults __ml/kg/min

Answer 9

6ml/kg/min compared to adults 3ml/kg/min

Question 10

What is closing volume, and should FRC be higher than it?

Answer 10

It is the lung volume at which small airways begin to close, and you want FRC to be higher!

Question 11

What are the neonates 02 consumption, alveolar ventilation, co2 production, TV, VC, FRC, and Pao2 on room air?

Answer 11

O2 consumption is 6 ml/kg/min (3 adults)
alveolar vent 130 ml/kg/min (60 adults)
co2 production 6 g/min (3)
TV 6 ml/kg SAME adult
VC 35 (70 adult)
FRC 25 ml/kg (40 adult)
Pao2 65-85 (85-95 adult)

Question 12

Mandibular hypoplasia is called?

Answer 12

Pierre Robin Sequence

Anterior larynx: larynx sits high under the base of the tongue: no space to displace the tongue, the larynx will remain anterior the laryngoscope blade

Question 13

Maxillary Hypoplasia

Answer 13

Changes to the mass-to-volume ratio of the upper airway is similar manner to tongue hyperplasia or mandibular hyperplasia

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

Question 14

Temporomandibular Joint

Answer 14

Opens the upper airway and translocates the lower jaw forward

Need to determine if restricted opening is fixed or can be overcome once anesthetized

Fixed: congenital conditions, previous trauma

Trismus: pain or inflammation: can be overcome

Question 15

Anatomic Abnormalities:

Vertebral Column

Answer 15

Flexion and extension

Align the axis of the trachea and oral cavity to provide a line of sight for intubation

Look if patient has vertebral fusion, hemivertebrae and arthritic changes may decrease cervical mobility so that tracheal intubation is difficult

Instability of the vertebral column that could impinge the spinal cord

Question 16

Anatomic Abnormalities: Soft Tissues

Answer 16

Limit movement of the airway

Affect mouth opening
Freeman-Sheldon Syndrome

Fixed microstomia

Fibrofacial myositis, dermatomyositis

Congenital: Macroglossia

Beckwih-Wiedeman Syndrome, Down’s Syndrome, Sturge-Weber Syndrome, Dwarfism

Soft tissue tumors, AV malformations

Question 17

Craniofacial Abnormalities

Answer 17

Synostosis
Clefting
Hypoplasia

Question 18

Craniofacial Abnormalities:Craniosynostosis

Answer 18

Apert, Crouzon, Pfeiffer.

All have some degree of midface hypoplasia

Question 19

Craniofacial Abnormalities:Craniosynostosis

Apert, Crouzon, Pfeiffer’s Syndromes

Answer 19

Hypertelorism, proptosis-Mandible is normal size but appears prognathic relative to midface hypoplasia

-Palate is high and arched-Nasal passages are small with some degree of choanal atresia

Crouzon Disease
-Hypertelorism, Craniostenosis, shallow orbits, proptosis, midface hypoplasia

Apert Disease
-as above in addition to syndactyly of all extremitiesAssociated cardiac and renal problems: hydronephrosis or PCKD (polycystic kidney disease), Possibility of esophogeal atresia

Question 20

Craniosynostosis is a birth defect in which the bones in a baby’s ?

Answer 20

baby’s skull join together too early. This happens before the baby’s brain is fully formed. As the baby’s brain grows, the skull can become more misshapen

Question 21

hypertelorism means

Answer 21

increased distance between two body parts

Question 22

Craniosynostosis Airway Problems

Answer 22

Obstructive apnea: may require long term tracheostomy to bypass obstruction
Vertebral abnormalities: may limit neck motion and tracheal ring abnormalities
May need a smaller ETT
Difficult mask fit due to midface hypoplasia and proptosis

Question 23

Vertebral Column

Answer 23

Flexion and extension

Align the axis of the trachea and oral cavity to provide a line of sight for intubation

Look if patient has vertebral fusion, hemivertebrae and arthritic changes may decrease cervical mobility so that tracheal intubation is difficult

Instability of the vertebral column that could impinge the spinal cord