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Paediatric difficult airway management: Difference between revisions
Paediatric difficult airway management (view source)
Revision as of 17:04, 12 February 2023
, 1 year ago→Premedication
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(30-40 micrograms.kg-1 PO or 20 micrograms.kg-1 IM). Peak effect of | (30-40 micrograms.kg-1 PO or 20 micrograms.kg-1 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. | ||
Anaesthetic technique | |||
=== Anaesthetic technique === | |||
The most important principle in managing the difficult airway in | The most important principle in managing the difficult airway in | ||
children is to maintain spontaneous ventilation until the airway is | children is to maintain spontaneous ventilation until the airway is | ||
| Line 450: | Line 451: | ||
of airway problems encountered in children means the anaesthetic | of airway problems encountered in children means the anaesthetic | ||
must be tailored to the individual situation: | must be tailored to the individual situation: | ||
:• Large extraoral tumours may mean a face mask will not fit | :• Large extraoral tumours may mean a face mask will not fit the child’s face, so an inhalational induction is impossible and IV induction/sedation must be used instead. | ||
the child’s face, so an inhalational induction is impossible and IV | :• Large intraoral tumours prevent laryngoscopy and the use of an LMA - nasal fibreoptic intubation (FOI) should be used. | ||
induction/sedation must be used instead. | :• Conditions such a noma (cancrum oris) often cause severe limitation of mouth opening - nasal FOI is likely to be required. | ||
:• Large intraoral tumours prevent laryngoscopy and the use of an | :• Other problems such as partial mouth opening, severe retrongathia or bony abnormalities (ameloblastoma) often make laryngoscopy difficult but do permit the insertion of an LMA if laryngoscopy proves impossible. | ||
LMA - nasal fibreoptic intubation (FOI) should be used. | :• Burns contractures causing fixed flexion of the neck may be released prior to intubation using ketamine anaesthesia and with local infiltration. | ||
:• Conditions such a noma (cancrum oris) often cause severe | |||
limitation of mouth opening - nasal FOI is likely to be required. | |||
:• Other problems such as partial mouth opening, severe retrongathia | |||
or bony abnormalities (ameloblastoma) often make laryngoscopy | |||
difficult but do permit the insertion of an LMA if laryngoscopy | |||
proves impossible. | |||
:• Burns contractures causing fixed flexion of the neck may be | |||
released prior to intubation using ketamine anaesthesia and with | |||
local infiltration. | |||
The variety of clinical conditions mean a one-size-fits all approach is | The variety of clinical conditions mean a one-size-fits all approach is | ||