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Paediatric difficult airway management: Difference between revisions
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Paediatric difficult airway management (view source)
Revision as of 16:56, 12 February 2023
, 1 year ago→2. Unexpected difficult tracheal intubation
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is more anecdotal than evidence-based. The choice is between a surgical | is more anecdotal than evidence-based. The choice is between a surgical | ||
or needle (cannula) technique for cricothyroidotomy. The technique | or needle (cannula) technique for cricothyroidotomy. The technique | ||
for cannula cricothroidotomy is shown in Figure 3, and for surgical | for cannula cricothroidotomy is shown in Figure 3, and for surgical cricothyroidotomy, in Table 2. | ||
[[File:CICV_Algorithm.jpg|800px|center|thumb|Figure 3: Can’t intubate can’t ventilate algorithm. Reproduced with kind permission of Association of Paediatric Anaesthetists ]] | [[File:CICV_Algorithm.jpg|800px|center|thumb|Figure 3: Can’t intubate can’t ventilate algorithm. Reproduced with kind permission of Association of Paediatric Anaesthetists ]] | ||
Table 2. Technique for surgical cricothyroidotomy | {| class="wikitable" | ||
1. Position the patient so that the neck is fully extended so that the trachea and larynx are pushed forward | |+Table 2. <i>Technique for surgical cricothyroidotomy</i> | ||
2. Locate the cricothyroid membrane and stabilise the trachea | |1. Position the patient so that the neck is fully extended so that the trachea and larynx are pushed forward | ||
3. With a scalpel blade make a stab incision through the skin and cricothyroid membrane* | |- | ||
4. Insert a tracheal hook or retractor at the lower edge of the incision | |2. Locate the cricothyroid membrane and stabilise the trachea | ||
5. Pass an appropriately sized tracheal or tracheostomy tube | |- | ||
6. Ventilate patient and assess effectiveness | |3. With a scalpel blade make a stab incision through the skin and cricothyroid membrane* | ||
7. Secure the tube | |- | ||
Arterial forceps, the scalpel blade and tracheal dilators may be used to dilate the orifice | |4. Insert a tracheal hook or retractor at the lower edge of the incision | ||
|- | |||
|5. Pass an appropriately sized tracheal or tracheostomy tube | |||
|- | |||
|6. Ventilate patient and assess effectiveness | |||
|- | |||
|7. Secure the tube | |||
|- | |||
<i>Arterial forceps, the scalpel blade and tracheal dilators may be used to dilate the orifice</i> | |||
|} | |||
Since there is no randomised controlled trial of one technique versus | Since there is no randomised controlled trial of one technique versus | ||
another, the choice should be determined by local experience and | another, the choice should be determined by local experience and | ||
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steps for difficult facemask ventilation should be tried first. If muscle | steps for difficult facemask ventilation should be tried first. If muscle | ||
relaxants have been used and can be reversed, wake the child up. | relaxants have been used and can be reversed, wake the child up. | ||
=== THE EXPECTED DIFFICULT AIRWAY === | === THE EXPECTED DIFFICULT AIRWAY === | ||
If the preoperative airway assessment alerts the anaesthetist to expected | If the preoperative airway assessment alerts the anaesthetist to expected | ||