Paediatric difficult airway management - Revision history

WikiSysop at 16:29, 14 February 2023

2023-02-14T16:29:26Z

← Older revision		Revision as of 16:29, 14 February 2023
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	{\| class="wikitable"		{\| class="wikitable"
	\|+Summary		\|+
	!Unexpected difficult airways in paediatric practice are rare. Many problems can be prevented by routine preoperative airway assessment, pre- oxygenation, and preparation of equipment. A simple step-wise approach to management improves outcome. Anaesthetists have a responsibility to be familiar with airway algorithms and make pragmatic modifications to account for available resources.		!Summary
			\|-
			\|Unexpected difficult airways in paediatric practice are rare. Many problems can be prevented by routine preoperative airway assessment, pre- oxygenation, and preparation of equipment. A simple step-wise approach to management improves outcome. Anaesthetists have a responsibility to be familiar with airway algorithms and make pragmatic modifications to account for available resources.
	\|}		\|}

WikiSysop at 03:36, 13 February 2023

2023-02-13T03:36:26Z

← Older revision		Revision as of 03:36, 13 February 2023
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	{\| class="wikitable"		{\| class="wikitable"
	\|+Summary		\|+Summary
	!Unexpected difficult airways in paediatric practice are rare. Many problems can be prevented by routine preoperative airway assessment, pre- ~~xygenation~~, and preparation of equipment. A simple step-wise approach to management improves outcome. Anaesthetists have a responsibility to be familiar with airway algorithms and make pragmatic modifications to account for available resources.		!Unexpected difficult airways in paediatric practice are rare. Many problems can be prevented by routine preoperative airway assessment, pre- oxygenation, and preparation of equipment. A simple step-wise approach to management improves outcome. Anaesthetists have a responsibility to be familiar with airway algorithms and make pragmatic modifications to account for available resources.
	\|}		\|}

WikiSysop: /* Anaesthetic technique */

2023-02-12T18:01:35Z

Anaesthetic technique

← Older revision		Revision as of 18:01, 12 February 2023
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	:• Fix two tracheal tubes together over the FOB; the LMA may be withdrawn over the tracheal tubes.		:• Fix two tracheal tubes together over the FOB; the LMA may be withdrawn over the tracheal tubes.
	:• Use an AEC.		:• Use an AEC.


	<i>Tracheostomy</i>		<i>Tracheostomy</i>

WikiSysop: /* Anaesthetic technique */

2023-02-12T18:01:18Z

Anaesthetic technique

← Older revision		Revision as of 18:01, 12 February 2023
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	Options include:		Options include:
	:• Leave the LMA in situ		:• Leave the LMA <i>in situ</i>
	:• Use a long tracheal tube (croup tube)		:• Use a long tracheal tube (croup tube)
	:• Fix two tracheal tubes together over the FOB; the LMA may be withdrawn over the tracheal tubes.		:• Fix two tracheal tubes together over the FOB; the LMA may be withdrawn over the tracheal tubes.
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	<i>Tracheostomy</i>		<i>Tracheostomy</i>

	A tracheostomy should be performed by an experienced practitioner,		A tracheostomy should be performed by an experienced practitioner,
	normally an ENT surgeon. Inhalational anaesthesia or small		normally an ENT surgeon. Inhalational anaesthesia or small

WikiSysop: /* Premedication */

2023-02-12T17:52:34Z

Premedication

← Older revision		Revision as of 17:52, 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<sup>-1</sup> is often appropriate. Atropine is useful as an antisialogue
	(30-40 micrograms.kg<sup>-1</sup> PO or 20 micrograms.kg<sup>-1</sup> 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.

WikiSysop at 17:51, 12 February 2023

2023-02-12T17:51:47Z

WikiSysop: /* CONCLUSION */

2023-02-12T17:49:10Z

CONCLUSION

@@ Line 538: / Line 538: @@
 a responsibility to be familiar with airway algorithms and make
 pragmatic modifications to account for available resources.
 == REFERENCES ==

WikiSysop: /* Anaesthetic technique */

2023-02-12T17:43:17Z

Anaesthetic technique

← Older revision		Revision as of 17:43, 12 February 2023
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	combination provides better conditions for laryngoscopy than when		combination provides better conditions for laryngoscopy than when
	using intravenous ketamine alone.		using intravenous ketamine alone.


	<i>Nasal fibreoptic intubation – general</i>		<i>Nasal fibreoptic intubation – general</i>

WikiSysop: /* 3. Cannot intubate, cannot ventilate (CICV) - ‘rescue techniques’ */

2023-02-12T17:42:21Z

3. Cannot intubate, cannot ventilate (CICV) - ‘rescue techniques’

← Older revision		Revision as of 17:42, 12 February 2023
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	\|}		\|}
	<i>*Arterial forceps, the scalpel blade and tracheal dilators may be used to dilate the orifice</i>		<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

WikiSysop: /* 3. Cannot intubate, cannot ventilate (CICV) - ‘rescue techniques’ */

2023-02-12T17:41:25Z

3. Cannot intubate, cannot ventilate (CICV) - ‘rescue techniques’

← Older revision		Revision as of 17:41, 12 February 2023
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	\|-		\|-
	\|}		\|}
	<i>Arterial forceps, the scalpel blade and tracheal dilators may be used to dilate the orifice</i>		<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

← Older revision		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