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Paediatric difficult airway management: Difference between revisions
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Paediatric difficult airway management (view source)
Revision as of 17:51, 12 February 2023
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Therefore, a small dose of sedative premedication, such as midazolam | Therefore, a small dose of sedative premedication, such as midazolam | ||
0.3-0.5mg.kg-1 is often appropriate. Atropine is useful as an antisialogue | 0.3-0.5mg.kg-1 is often appropriate. Atropine is useful as an antisialogue | ||
(30-40 micrograms.kg-1 PO or 20 micrograms.kg-1 IM). Peak effect of | (30-40 micrograms.kg<sup>-1</sup> PO or 20 micrograms.kg<sup>-1</sup> IM). Peak effect of | ||
atropine is 90 minutes if given PO, 25 minutes if given IM. | atropine is 90 minutes if given PO, 25 minutes if given IM. | ||
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If inhalational induction is impossible, small doses of IV induction | If inhalational induction is impossible, small doses of IV induction | ||
agent should be given to induce loss of consciousness but still | agent should be given to induce loss of consciousness but still | ||
preserving spontaneous ventilation. Propofol 0.5-1mg.kg-1 or ketamine | preserving spontaneous ventilation. Propofol 0.5-1mg.kg<sup>-1</sup> or ketamine | ||
0.5-1mg.kg-1 should be given and titrated to effect. | 0.5-1mg.kg<sup>-1</sup> should be given and titrated to effect. | ||
If inhalational induction is not possible due to pain, for instance, from | If inhalational induction is not possible due to pain, for instance, from | ||
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:• Maintain anaesthesia either with incremental doses of ketamine or inhalational anaesthesia either via a nasal airway in the other nostril connected to the breathing circuit or using a specially designed facemask with a port for insertion of the fibreoptic bronchoscope. | :• Maintain anaesthesia either with incremental doses of ketamine or inhalational anaesthesia either via a nasal airway in the other nostril connected to the breathing circuit or using a specially designed facemask with a port for insertion of the fibreoptic bronchoscope. | ||
:• Use a topical vasoconstrictor to prevent bleeding from the nose during FOI, as otherwise this may make intubation impossible. Pseudoephedrine, ephedrine, phenylephrine, oxymetazoline, or nasal packs soaked in 1:10,000 adrenaline may be used, depending on local availability. | :• Use a topical vasoconstrictor to prevent bleeding from the nose during FOI, as otherwise this may make intubation impossible. Pseudoephedrine, ephedrine, phenylephrine, oxymetazoline, or nasal packs soaked in 1:10,000 adrenaline may be used, depending on local availability. | ||
:• Apply topical lidocaine to the nose and oropharynx. Larger fibreoptic laryngoscopes often have a channel through which local anaesthesia can be injected. Alternatively an epidural catheter can be passed through the suction port (if present) and local anaesthetic injected through this. Be careful not to exceed the maximum dose of lidocaine (3mg.kg-1 i.e. 0.3ml.kg-1 of a 1% solution). | :• Apply topical lidocaine to the nose and oropharynx. Larger fibreoptic laryngoscopes often have a channel through which local anaesthesia can be injected. Alternatively an epidural catheter can be passed through the suction port (if present) and local anaesthetic injected through this. Be careful not to exceed the maximum dose of lidocaine (3mg.kg<sup>-1</sup> i.e. 0.3ml.kg<sup>-1</sup> of a 1% solution). | ||
The correct size of tracheal tube is critical to success. Too large a | The correct size of tracheal tube is critical to success. Too large a | ||