Peds week 3 Flashcards
Normal Pediatric Airway
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
More Normal Pediatric Airway
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
Pediatric Physiology
reduced lung compliance
small and limited number of alveoli
increased chest wall compliance
cartilaginous ribcage
weak intercostal and diaphragmatic musculature
Peds have a smaller number of type ___ fibers
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
Peds have a ____ rate of o2 consumption
higher
Peds are prone to ______ and ________ when apneic
Prone to atelectasis and hypoxemia when apneic
Peds _____ and _____ respiratory drives are not well developed
Hypercapnic and hypoxic respiratory drives not well developed
During apnea, PAC02 will rise __mmHg during the first minutes and then ____mmHg each minute after
During apnea, PAC02 will rise 6mmHg during the first minutes and then 3-4mmHg each minute after
HIGHER rate of o2 consumption compared to adults. ___ml/kg/min compared to adults __ml/kg/min
6ml/kg/min compared to adults 3ml/kg/min
What is closing volume, and should FRC be higher than it?
It is the lung volume at which small airways begin to close, and you want FRC to be higher!
What are the neonates 02 consumption, alveolar ventilation, co2 production, TV, VC, FRC, and Pao2 on room air?
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)
Mandibular hypoplasia is called?
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
Maxillary Hypoplasia
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
Temporomandibular Joint
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
Anatomic Abnormalities:
Vertebral Column
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
Anatomic Abnormalities: Soft Tissues
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
Craniofacial Abnormalities
Synostosis
Clefting
Hypoplasia
Craniofacial Abnormalities:Craniosynostosis
Apert, Crouzon, Pfeiffer.
All have some degree of midface hypoplasia
Craniofacial Abnormalities:Craniosynostosis
Apert, Crouzon, Pfeiffer’s Syndromes
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
Craniosynostosis is a birth defect in which the bones in a baby’s ?
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
hypertelorism means
increased distance between two body parts
Craniosynostosis Airway Problems
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
Vertebral Column
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
