Book contents
- Frontmatter
- Contents
- List of contributors
- Preface
- Acknowledgements
- List of abbreviations
- 1 Anatomy
- 2 Physiology of apnoea and hypoxia
- 3 Physics and physiology
- 4 Cleaning and disinfection of airway equipment
- 5 General principles
- 6 Maintenance of the airway during anaesthesia: supra-glottic devices
- 7 Tracheal tubes
- 8 Tracheal intubation of the adult patient
- 9 Confirmation of tracheal intubation
- 10 Extubation
- 11 Light-guided intubation: the trachlight
- 12 Fibreoptic intubation
- 13 Retrograde intubation
- 14 Endobronchial and double-lumen tubes, bronchial blockers
- 15 ‘Difficult airways’: causation and prediction
- 16 The paediatric airway
- 17 Obstructive sleep apnoea and anaesthesia
- 18 The airway in cervical trauma
- 19 The airway in cervical spine disease and surgery
- 20 The aspiration problem
- 21 The lost airway
- 22 Trauma to the airway
- 23 Airway mortality associated with anaesthesia and medico-legal aspects
- 24 ENT and maxillofacial surgery
- 25 Airway management in the ICU
- 26 The airway in obstetrics
- Index
16 - The paediatric airway
Published online by Cambridge University Press: 15 December 2009
- Frontmatter
- Contents
- List of contributors
- Preface
- Acknowledgements
- List of abbreviations
- 1 Anatomy
- 2 Physiology of apnoea and hypoxia
- 3 Physics and physiology
- 4 Cleaning and disinfection of airway equipment
- 5 General principles
- 6 Maintenance of the airway during anaesthesia: supra-glottic devices
- 7 Tracheal tubes
- 8 Tracheal intubation of the adult patient
- 9 Confirmation of tracheal intubation
- 10 Extubation
- 11 Light-guided intubation: the trachlight
- 12 Fibreoptic intubation
- 13 Retrograde intubation
- 14 Endobronchial and double-lumen tubes, bronchial blockers
- 15 ‘Difficult airways’: causation and prediction
- 16 The paediatric airway
- 17 Obstructive sleep apnoea and anaesthesia
- 18 The airway in cervical trauma
- 19 The airway in cervical spine disease and surgery
- 20 The aspiration problem
- 21 The lost airway
- 22 Trauma to the airway
- 23 Airway mortality associated with anaesthesia and medico-legal aspects
- 24 ENT and maxillofacial surgery
- 25 Airway management in the ICU
- 26 The airway in obstetrics
- Index
Summary
Anatomical and physiological differences
At birth the human larynx is well developed for the demands of life and the neonate is capable of breathing, limited phonation, and airway protection during feeding. The larynx lies opposite the third cervical vertebra and the epiglottis is long and curled, often in the classical ω shape and is in frequent contact with the soft palate during the first 6 months of age. This allows for feeding and breathing to occur simultaneously by interlocking of these structures, creating lateral channels for feeding and a central passage for breathing via the nasal airway. This situation lasts for 12–18 months. The tongue is large relative to the mandibular space and fills the oral cavity, allowing the tongue to protrude during feeding. Infants are preferential nasal breathers and the presence of nasal obstruction (e.g. choanal atresia) can cause significant airway problems.
The subglottic area in the term-baby is funnel shaped from the top down and the posterior lamina of the cricoid ring is tilted back and inferiorly making it particularly susceptible to trauma during endotracheal intubation. The smaller size of the paediatric airway means that a small decrease in diameter may cause significant airway obstruction. The cricoid ring is the narrowest part of the child's airway. The length of the trachea in the newborn is 5–6 cm and increases during the first year of life to about 8 cm. The epiglottis moves away from the soft palate at around 6 months and the tongue descends into the pharynx at about 1 year of age allowing greater phonation. The differences between the infant and the older child's skull can be seen in Figure 16.1.
- Type
- Chapter
- Information
- Core Topics in Airway Management , pp. 123 - 130Publisher: Cambridge University PressPrint publication year: 2005
- 3
- Cited by