Outline the principles of airway management in paediatric anaesthesia, including the use of different airway devices and techniques?

Indunil Karunarathna @Indunil-Karunarathna

10 April 2024 1 8K Report

The principles of airway management in paediatric anaesthesia are crucial for ensuring adequate oxygenation, ventilation, and prevention of complications during surgery.

Indunil Karunarathna

The principles of airway management in paediatric anaesthesia are crucial for ensuring adequate oxygenation, ventilation, and prevention of complications during surgery. Here's an outline of the key principles and techniques, along with the use of different airway devices:

Assessment of the Pediatric Airway:Conduct a thorough assessment of the paediatric airway, considering anatomical differences, developmental stage, and potential predictors of difficult intubation. Evaluate for any airway abnormalities, such as congenital anomalies, masses, or syndromic features that may affect airway management decisions.

Preoxygenation:Preoxygenate the child before induction of anaesthesia to prolong the safe apnea time and minimize the risk of hypoxemia during airway manipulation. Utilize a high-flow oxygen delivery system or a tight-fitting face mask to achieve optimal preoxygenation.

Induction of Anaesthesia:Select appropriate induction agents and techniques based on the child's age, medical condition, and airway assessment. Consider the use of intravenous induction agents, inhalational agents, or a combination of both for smooth and rapid induction while maintaining airway patency.

Airway Maintenance:Maintain airway patency and adequate ventilation throughout the perioperative period using appropriate airway devices and adjuncts. Consider the use of oral airways, nasal airways, or nasopharyngeal airways to prevent airway obstruction and facilitate ventilation, particularly in younger children and infants.

Endotracheal Intubation:Perform endotracheal intubation when prolonged airway control is required, or in cases where there is a risk of aspiration, airway obstruction, or difficulty with mask ventilation. Select the appropriate size endotracheal tube based on the child's age, weight, and airway anatomy, ensuring a snug fit without excessive pressure or trauma.

Supraglottic Airways (SGAs):Consider the use of supraglottic airway devices, such as laryngeal mask airways (LMAs) or i-gel devices, as alternatives to endotracheal intubation in certain paediatric populations. SGAs can provide effective ventilation and airway support, particularly in elective surgeries with a low risk of aspiration or airway compromise.

Emergency Airway Management:Be prepared to manage difficult airways and emergencies promptly, including the use of advanced airway techniques such as fibreoptic intubation, video laryngoscopy, or surgical airway access (cricothyroidotomy or tracheostomy). Ensure availability of appropriate equipment, expertise, and resources for emergency airway management in paediatric patients.

Post-intubation Care:Confirm correct endotracheal tube placement and secure the tube properly to prevent accidental dislodgement or malposition. Monitor for signs of tube obstruction, endobronchial intubation, or ventilator-associated complications, and adjust ventilation parameters accordingly.

Extubation and Recovery:Plan for safe extubation in a controlled environment with appropriate monitoring and support to minimize the risk of post-extubation complications. Ensure adequate reversal of neuromuscular blockade and optimal respiratory function before extubation, particularly in children at risk of airway collapse or obstruction.

By adhering to these principles and techniques, anaesthesia providers can effectively manage the paediatric airway, maintain optimal oxygenation and ventilation, and minimize the risk of airway-related complications during surgery and anaesthesia. Close attention to patient assessment, selection of appropriate airway devices, and readiness to manage emergencies is essential for ensuring safe and successful airway management in paediatric patients.

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