Paediatric Airway Management: A Few Tips And Tricks
Paediatric Airway Management:A few tips and tricksStefan Sabato March 2014
Disclosures1) I am not an airway wizard.2) Airway management in children can bescary.3) There are no secrets or magical pieces ofequipment4) Airway training is an ongoing process. Skillacquisition and retention requiresdedicated whole day workshops
Consultant anaesthetists have airway complicationsNot because of a lack of skills, but because of human factors Poor assessmentPoor planningPoor decision makingFibreoptic intubation not done when indicatedFixation error
Children vs Adults: The Good True difficult laryngoscopy is rare(1.3%)
Children vs Adults: The Bad But, Canʼt intubate awake Often induce with IV access
Children vs Adults: The Ugly Also, when do you bail out?
What is a difficult alFunctionalB Regli-von Ungern-Sternberg. Pediatric Anesthesia 2012; 22: 521-526
Predicting Difficult Laryngoscopy in kids Age below 1 year Low BMI Mallampatti* ASA Faciomaxillary and cardiac surgeryS Heinrich et al. Pediatric Anesthesia 2012; 22: 729 - 736
Scenario 1: Chubby Infant No IV access during a gas induction is tricky If either the IV access, or the anaesthetic, arehard: have 2 experienced pairs of hands
Scenario 2: The art of the gasinduction
Scenario 3: Laryngospasm Very common cause ofhypoxia Spectrum of severity Best if nipped in the bud
Laryngospasm Risk Factors PHx of laryngospasm, asthma, smoking, GORDRecent URTISecretions/Blood in airwayMultiple attempts at airway instrumentationStimulation during the “in between” phaseENT and airway surgeryInexperienced (paediatric) anaesthetistA Ahmad Al-alami et al. Curr Opin Anaesthesiol 2009; 22: 388-395
Laryngospasm Prevention Cancel case Avoid irritant volatiles ?Opioids and propofol use Management CPAP Propofol Suxamethonium
Laryngospasm controversies ETT vs LMA Deep vs Light IV lignocaine prophylaxis and treatment
Scenario 4: Planning Elaine Bromiley
Example Plan for aneonate Plan A:" 3.5 ETT ready, size 1 Macintosh laryngoscope blade" Small orange Bougie (pre bent), have a size 1 Miller blade available" Have a shoulder roll ready, but I wonʼt put it in place" Have a white guedel airway available if I am having difficulty with ventilation" If that doesnʼt work I will do the 2 person technique" We will ventilate the patient between attempts, and I only want to spend about 5 minutes on Plan A before moving to Plan B" Plan B" Size 1.5 laryngeal mask, call in charge anaesthetist on x52000" Use Glidescope" Plan C" Maintain oxygenation, get ENT for a tracheostomy" Plan D" Open CICO pack, and perform cannula cricothyroidotomy "
Scenario 5: GlideScope Donʼt get too close Relax the lifting force Parker or “bullet tipped” ETTs Rotating ETT Introducer shy of the tip and a warmed tube helps Similarities to nasal intubation: lifting the head, rotating ETT
GlideScope Prepare the ETT with stylet Proprietary stylet only fits a 6 ETT Mouth - Screen - Mouth - Screen “Seeing is not believing” Documentation
What we havenʼt talkedabout today Flexible intubating bronchoscopy(fibreoptic) Management of the CICO scenario stefan.sabato@rch.org.au
Paediatric Airway Management: A few tips and tricks! Stefan Sabato" March 2014! Disclosures! 1) I am not an airway wizard.! 2) Airway management in children can be scary.! 3) There are no secrets or magical pieces of equipment! 4)
The ASA difficult airway algorithm is a useful starting point to consider in airway management in the trauma patient. Table 1 lists the eleven for the components of the airway examination recommended ASA difficult airway algorithm. Table 2 lists some suggested contents of difficult airway
Airway A Breathing Circulation Disability Exposure Assess Airway Is it compromised? Yes No Get immediate help If airway is compromised, commence basic life support Assess breathing Is the patient choking or distressed? (complete airway obstruction is silent). Is the airway obstructed? (is there stridor/use of accessory muscles)? A Airway
6 Professional and CliniCal standards for safe PaediatriC anaesthesia 29 7 PerforManCe MeasUres and QUalitY iMProVeMent Methods for 36 PaediatriC anaesthesia and intensiVe Care MediCine in ireland 8 PaediatriC CritiCal Care 43 9 strUCtUre and GoVernanCe of PaediatriC anaesthesia s
UK standards for paediatric endocrinology 2010 Paediatric endocrinology is a designated specialised service in the UK1-3. The first UK Paediatric Endocrine Standards were developed by the Clinical Committee of the British Society for Paediatric Endocrinology and Diabetes (BSPED) and published in 20105. The standards emphasised the need for well .
An airway plan suggests a single approach to management of the airway. An airway strategy is a co-ordinated, logical sequence of plans, which aim to achieve good gas exchange and prevention of aspiration. Anaesthetists should approach airway management with strategies rather than plans.
Jul 21, 2021 · Crash Airway—unresponsive state, unreactive, near death and unlikely to respond to laryngoscopy Difficult Airway—ROMAN, LEMON, RODS, SMART Forced to Act—difficult airway about to become a crash airway if action not taken
– Circulation – Disability – Exposure . Primary Survey--Airway . – Insert oral or nasal airway – Airway intubation – Surgical airway (eg cricothyroidotomy, tracheostomy) Primary Survey--Breathing Assess along with airway
The section on illustration greatly benefited from Lys Drewett s ten years experience teaching archaeological illustration at the Institute of Archaeology and as illustrator on all my archaeological projects. Most of the illustrations derive from my field projects but, where not, these are gratefully acknowledged under the illustration. To any other archaeologists who feel I may have used .
