Presentation on theme: "Company Name Airway Management in Children Eddy Cousinery - RCH."— Presentation transcript:
Company Name Airway Management in Children Eddy Cousinery - RCH
1.Paediatric Anatomy 2.How to assess an airway 3.How to prepare for a predicted difficult airway 4.How to manage the “easy airway” in trouble OVERVIEW
Paediatric Anatomy Airway Head Larger (occiput) TongueRelatively large LarynxHigher(C2-C3) & appears anterior EpiglottisLarger/U Shaped
How to assess an airway? Use the Mallampati classification to identify degree of difficulty or ease of the airway Class 2 - Arytenoids cartilages and posterior part of vocal chords visible Class 1 - - Visualisation of the vocal chords Class 3 - Epiglottis visible Class 4 - Epiglottis not visible
How to assess an airway? (Almost) all difficult airways in children can be predicted by: History Well with a normal voice? No OSA? Do they have a condition associated with difficult airway ? Examination –Stridor/abnormal voice (eg. Laryngeal papilloma/ burn –Dysmorphic features
What Equipment? Depends on plan, but: SIMPLE equipment should not be forgotten (Eg. Co 2 monitoring) in favour of the expensive and complicated. BOUGIES=VITAL Advanced Fibre-optic – ready to use and planned how to use
Easy airway in trouble management Any airway can turn into a compromised airway Most common in children is Laryngospasm.
Scenario An airway develops acute obstruction after extubation, what approach do we take?
100% oxygen, mask, call for help Open airway manoeuvres, T-piece Positive pressure to airway by mask (CPAP) Immediate management
Laryngospasm Management How to proceed? Partial Complete
Secure Taping Formula to calculate tube size ETT: 3.5kg 3.5mm ETT: size mm = 4 + age/4: length (cm) at lip = 12 + age/2 at nose = 15 + age/2
SUMMARY Almost all difficult airways in children can be predicted by the presence of dysmorphism or the history of a condition which is associated with a difficult airway. Careful Assessment, Strategic planning, communication, correct personnel and equipment are the keys to success.
SUMMARY A recent UK audit demonstrated airway disasters are rare but occur with devastating effects. The causes were often related to: Poor judgement (inadequate assessment, poor strategic planning, persisting in trying techniques that have already failed). Lack of Education and training was also identified as a cause.
Acknowledgement My sincere thanks for their help in developing this presentation : Dr Adam Skinner Dr Phil Ragg Dr Nick Martin References: Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: Anaesthesia" Cook TM, Woodall N, Ferk C. Br J Anaesth 2011; 106: 617-631 Proposal for the management of the unexpected difficult pediatric airway, Markus Weiss & Thomas Engelhardt – Pediatric Anaesthesia 2010; 20 454-464