- Paediatric difficult airway
- Anatomical differences
- Large tongue
- Cephalad larynx
- Epiglottis hard, narrow and omega shaped
- Narrowest part is cricoid ring
- Narrower airway so small decrease can have large effect
- O₂ consumption high at 7ml/kg/min
- Large occiput
- Conditions
- Craniofacial
- Pierre-Robin
- Treacher-Collins
- Goldenhar's syndrome
- Crouzon's syndrome
- Lysosomal enzyme defects
- Congenital swellings
- Cystic hygroma
- Haemangioblastoma
- TMJ problems
- Still's disease
- Cockayne-Touraine syndrome
- Acquired pathology
- Thermal injury
- Abscesses
- Tumour
- Post-radiation
- Management
- Aim to maintain SV
- Use 100% O₂ with sevoflurane
- Adjuncts may be helpful
- NPA
- Guedel
- Avoid assisted ventilation
- Avoid muscle relaxants
- The patient may need to be awoken if an airway can not be established
- Fibreoptic intubation
- Maintain anaesthesia via a nasal airway attached to a breathing circuit if nasal route used
- Via an LMA is more common
- Railroad tube over bronchoscope
- Use a guidewire and airway exchange catheter
- Use airway catheter only
- Cricothyroidotomy
- Connect luer lock via a Y connector to an oxygen flowmeter and set flow (in L/min) to the child's age in yrs. Occlude the open end of the Y connector for 1s to use
- Special considerations in neonates
- Awake intubation after 20μcg/kg atropine
- Oxyscope may be used
- Causes stress induced physiological changes
- Bronchoscope can be used (ultra thin bronchoscope) via LMA or nasal route
- Rigid bronchoscopy can also be used and a boogie placed
- Fetal surgery can be done for large masses using placental oxygenation until the airway is secured!
- CEACCP
Link:ceaccp.oxfordjournals.org/content/3/6/167.full.pdf