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Paediatric difficult airway management: Difference between revisions
Paediatric difficult airway management (view source)
Revision as of 16:47, 12 February 2023
, 1 year ago→2. Unexpected difficult tracheal intubation
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Alternate techniques | <i>Alternate techniques</i> | ||
Traditional laryngoscopes (curved, straight or McCoy levering blades) | Traditional laryngoscopes (curved, straight or McCoy levering blades) | ||
give a direct view of the larynx. Alternate techniques use an indirect | give a direct view of the larynx. Alternate techniques use an indirect | ||
approach with flexible or rigid equipment. | approach with flexible or rigid equipment. | ||
• Flexible indirect laryngoscopy, in the form of fibreoptic intubation, | |||
is the established ‘gold standard’ for the management of the | :• Flexible indirect laryngoscopy, in the form of fibreoptic intubation, is the established ‘gold standard’ for the management of the predicted difficult airway in adults (see below). | ||
predicted difficult airway in adults (see below). | :• New rigid indirect laryngoscopes are available, including in paediatric sizes. Rigid indirect laryngoscopy has a place in the unexpected difficult tracheal intubation algorithm. The choice of device depends on local availability and expertise. | ||
• New rigid indirect laryngoscopes are available, including in | |||
paediatric sizes. Rigid indirect laryngoscopy has a place in the | |||
unexpected difficult tracheal intubation algorithm. The choice of | |||
device depends on local availability and expertise. | |||
If visualising the larynx is impossible, then an LMA should be inserted. | If visualising the larynx is impossible, then an LMA should be inserted. | ||
LMAs provide a clear airway in the vast majority of children. This | LMAs provide a clear airway in the vast majority of children. This | ||
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If LMA insertion fails, then oxygenation and ventilation must be | If LMA insertion fails, then oxygenation and ventilation must be | ||
provided by mask ventilation. | provided by mask ventilation. | ||
3. Cannot intubate, cannot ventilate (CICV) - ‘rescue | |||
techniques’ | == 3. Cannot intubate, cannot ventilate (CICV) - ‘rescue techniques’ == | ||
A simple algorithm for the management of ‘cannot intubate, cannot | A simple algorithm for the management of ‘cannot intubate, cannot | ||
ventilate’ is given in Figure 3 | ventilate’ is given in Figure 3. | ||
Rescue techniques for the CICV situation have been extensively | Rescue techniques for the CICV situation have been extensively | ||
researched in the adult literature, but their use in paediatric emergencies | researched in the adult literature, but their use in paediatric emergencies | ||
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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 | ||
difficulties in airway management then there are three key questions: | difficulties in airway management then there are three key questions: | ||