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Paediatric difficult airway management: Difference between revisions
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Paediatric difficult airway management (view source)
Revision as of 17:19, 12 February 2023
, 1 year ago→THE EXPECTED DIFFICULT AIRWAY
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If the preoperative airway assessment alerts the anaesthetist to expected | If the preoperative airway assessment alerts the anaesthetist to expected | ||
difficulties in airway management then there are three key questions: | difficulties in airway management then there are three key questions: | ||
:1. Does the anaesthetist have the necessary paediatric airway | :1. Does the anaesthetist have the necessary paediatric airway experience? | ||
experience? | |||
:2. Does the hospital have the necessary paediatric equipment? | :2. Does the hospital have the necessary paediatric equipment? | ||
:3. Does the relative benefit of the planned surgery outweigh the | :3. Does the relative benefit of the planned surgery outweigh the possible risks of anaesthesia? | ||
possible risks of anaesthesia? | |||
If there is any doubt, full discussion should take place with the parents | If there is any doubt, full discussion should take place with the parents | ||
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The primary plan for management of the expected difficult paediatric | The primary plan for management of the expected difficult paediatric | ||
airway will likely be one of the following: | airway will likely be one of the following: | ||
:1. Laryngoscopy anticipated to be difficult but may be possible: | :1. Laryngoscopy anticipated to be difficult but may be possible: Attempt laryngoscopy and intubation. If fails, consider repositioning and try alternate laryngoscopes if available, or insert LMA and perform fibreoptic intubation (FOI) via LMA. | ||
Attempt laryngoscopy and intubation. If fails, consider | :2. Laryngoscopy predicted to be impossible: Perform nasal FOI or insert LMA and perform FOI via LMA. | ||
repositioning and try alternate laryngoscopes if available, or insert | :3. Laryngoscopy and LMA insertion known to be impossible: perform nasal FOI. | ||
LMA and perform fibreoptic intubation (FOI) via LMA. | :4. Laryngoscopy, LMA insertion and nasal FOI not available or known to be impossible: perform tracheostomy either using inhalational anaesthesia via face mask or intravenous ketamine especially if face mask anaesthesia impossible. | ||
:2. Laryngoscopy predicted to be impossible: Perform nasal FOI or | |||
insert LMA and perform FOI via LMA. | |||
:3. Laryngoscopy and LMA insertion known to be impossible: | |||
perform nasal FOI. | |||
:4. Laryngoscopy, LMA insertion and nasal FOI not available | |||
or known to be impossible: perform tracheostomy either using | |||
inhalational anaesthesia via face mask or intravenous ketamine | |||
especially if face mask anaesthesia impossible. | |||
Blind intubation through an LMA is NOT recommended in children | Blind intubation through an LMA is NOT recommended in children | ||