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Chapter 23 - The Paediatric Airway

from Section 2 - Airway Management: Clinical Settings and Subspecialties

Published online by Cambridge University Press:  03 October 2020

Tim Cook
Affiliation:
Royal United Hospital, Bath, UK
Michael Seltz Kristensen
Affiliation:
Rigshospitalet, Copenhagen University Hospital, Denmark
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Summary

Paediatric anaesthesia and airway management is in many ways similar to adult practice; however, deep understanding of the differences in anatomy, physiology and behavioural psychology is necessary, particularly in younger children and infants. This chapter aims to provide the anaesthetist with information on these differences and (re)introduce techniques and practical tips that may help practitioners with airway management in this population. The broad range of equipment sizes and drug doses are a challenge to memorise and guides are highly advised. While difficult airways are less frequent in children, their management can be challenging. Upper airway obstruction is a particularly frequent occurrence, and should be anticipated and prevented, focussing on basic, and much underappreciated, skills such as positioning, effective bag-mask ventilation and occasional careful use of adjuncts. Safe and non-traumatic practice is key. It is important to stress that modern devices such as videolaryngoscopes should be used carefully and under visual guidance at all times. Awake flexible optical bronchoscope (FOB)-guided intubation is the gold standard in adult difficult airway management. In paediatric practice, however, advanced airway procedures may need to be performed with prior general anaesthesia. We offer an introduction to some advanced techniques including paediatric emergency front of neck airway.

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Chapter
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Publisher: Cambridge University Press
Print publication year: 2020

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References

Further Reading

Cote, CJ, Hartnick, CJ. (2009). Pediatric transtracheal and cricothyrotomy airway devices for emergency use: which are appropriate for infants and children? Paediatric Anaesthesia, 19, 6676.CrossRefGoogle ScholarPubMed
Fidkowaki, CW, Zheng, H, Firth, PG. (2010). The anesthetic considerations of tracheobronchial foreign bodies in children: a literature review of 12,979 cases. Anesthesia & Analgesia, 111, 10161025.CrossRefGoogle Scholar
Habre, W, Disma, N, Virag, K, et al.; APRICOT Group of the European Society of Anaesthesiology Clinical Trial Network. (2017), Incidence of severe critical events in paediatric anaesthesia (APRICOT): a prospective multicentre observational study in 261 hospitals in Europe. Lancet Respiratory Medicine, 5, 412425.CrossRefGoogle ScholarPubMed
Holm-Knudsen, RJ, Rasmussen, LS, Charabi, B, Bøttger, M, Kristensen, MS. (2012). Emergency airway access in children – transtracheal cannulas and tracheotomy assessed in a porcine model. Paediatric Anaesthesia, 22, 11591165.Google Scholar
Jagannathan, N, Sequera-Ramos, L, Sohn, L, et al. (2014). Elective use of supraglottic airway devices for primary airway management in children with difficult airways. British Journal of Anaesthesia, 112, 742748.CrossRefGoogle ScholarPubMed
Weiss, M, Engelhart, T. (2010). Proposal for the management of the unexpected difficult pediatric airway. Paediatric Anaesthesia, 20, 454464.CrossRefGoogle ScholarPubMed

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