|
Considerations
- Large
occiput requires optimal head positioning
- Rapid
desaturation with apnea
- Intravenous
access
- Limited
ability to perform awake/sedated intubations
Anatomy
| |
Infant
|
Adult
|
|
Tongue
|
Relatively
large
|
Normal
|
|
Epiglottis
|
Floppy,
angled posteriorly
|
Firm,
less posterior angle
|
|
Vocal
cord angle
|
Inclined
|
Flat
|
|
Glottis
|
C3-C4
level
|
C5
level
|
|
Cricothyroid
Membrane
|
Small
|
Normal
|
|
Trachea
|
Small,
mobile, posterior displacement into thorax
|
Large,
stationary, vertical descent into thorax
|
Devices
LMA:
-
Can be used as definitive airway for many procedures
- Conduit
for fiberoptic intubation
- Can
be a temporizing airway while other options are pursued
- Essential
tool for failed intubation/failed ventilation
LMA
Size
|
Pediatric
Size
|
|
1
|
Neonates/infants
0-5 kg
|
|
1
1/2
|
Infants
between 5-10 kg
|
|
2
|
Infants/children
between 10-20 kg
|
|
2
1/2
|
Children
between 20-30 kg
|
|
3
|
Children
over 30 kg
|
Flexible
Fiberoptic Scope:
- Most
useful in the abnormal airway
- Oral
or nasal routes
- Difficult
with secretions/blood
- Requires
skill & practice
Lightwand:
- Pediatric
sizes are available
- Technique
is similar to adults
- May
be performed in awake/sedated patients
- May
be used as adjunct device
Rigid
Fiberoptic Scope:
- Bullard™
scope available in 2 pediatric sizes
- Technique
similar to adults
- Better
tolerated in awake (infant) laryngoscopy
- Beware
excess secretions
Combitube™:
-
Available in small adult (SA) size, suitable for patients over
4 feet
- The
glottic opening may be too small until a child has reached at
least the age of 12 years
Intubating
LMA - Fastrach™:
- Size
#3 Fastrach™ may be used for children 30-50 kg
- Allows
passage of a 7.0, 7.5 or 8.0 mm cuffed ET tube
- Use
recommended silicone tube when available
- Use
fiberoptic guidance when difficulty is encountered
Combined Techniques:
- Retrograde
wire and the flexible fibreoptic scope
- Rigid
laryngoscopy and the flexible fiberoptic scope
- LMA
and the lightwand or intubation stylette
- Retrograde
wire and the lightwand
References:
- Riazi
J (ed). "The Difficult Pediatric Airway." Anesthesiology
Clinics of North America. vol 16, no 4, 1998.
|
