Peds Airway

Question 1

peds vs adult airway

Answer 1

larger tongue
smaller pharynx
larger/floppy epiglottis
larynx anterior

Question 2

where is peds airway narrowest?

Answer 2

at cricoid!!

Question 3

difference in trachea in peds pts?

Answer 3

more narrow and less rigid

Question 4

difference in peds tongue

Answer 4

Proportionately larger than adult = increased risk of obstruction. Also more difficult to move with laryngoscope

Question 5

peds laryngeal position?

Answer 5

C3-4 (Adult: C4- C5)

Question 6

why must we use straight blade in peds?

Answer 6

more acute angle to visualize glottic opening

Question 7

epiglottis difference in peds?

Answer 7

Narrow, Ω shaped, angled away from axis of the trachea

[adults flat, parallel, broad]

Question 8

vocal chords in peds?

Answer 8

more caudad on anterior, results in more difficult intubation

Question 9

most narrow part of infant airway

Answer 9

cricoid cartilage or area immediately below

Question 10

what can be the result cricoid ring being nonexpandable?

Answer 10

Tight ETT = edema = reduced luminal diameter = increased airway resistance and post-extubation croup

Question 11

2 things to remember about cricoid ring?

Answer 11

nonexpandable and elliptical

Question 12

Infant tracheal diameter

Answer 12

4mm (adults is 8)

Question 13

1 mm of circumferential edema =

Answer 13

75% cross sectional decrease in the infant - 44% decrease in the adult

Question 14

when does peds airway reach adult proportions?

Answer 14

10-12 yrs

Question 15

Infants: Obligate nasal breathers, nasal obstruction can cause?

Answer 15

hypoxia

Question 16

when do peds have adequate mouth breathing

Answer 16

3-5 months

Question 17

why are peds More likely to have airway become distended or obstructed

Answer 17

↑ compliance of larynx, trachea, bronchi

Question 18

Loss of spontaneous ventilation (GA) and vigorous crying causes

Answer 18

dynamic airway collapse

Question 19

how do peds compensate for 2x O2 consumption of adults

Answer 19

increased RR

Question 20

Obstruction during Anesthesia mostly caused by

Answer 20

loss of airway muscle tone

Question 21

how to treat obstruction with anesthesia

Answer 21

continuous positive airway pressure (CPAP)
chin lift & jaw thrust
lateral position
Most effective overall: Jaw thrust

Question 22

Upper respiratory infection (URI) can cause

Answer 22

↑ risk of laryngospasm, bronchospasm, edema

Question 23

signs of big adenoids, tonsils, OSA

Answer 23

snoring, noisy breathing

Question 24

sign of subglottic stenosis, foreign body.

Answer 24

croupy cough

Question 25

Inspiratory stridor can be

Answer 25

laryngomalacia, laryngeal web, foreign body.

Question 26

can be vocal cord palsy, papillomas

Answer 26

hoarseness

Question 27

Wheezing can be d/t

Answer 27

asthma, bronchitis, foreign body.

Question 28

when should intubation not be delayed

Answer 28

for diagnostics when severe hypoxia present

Question 29

use a straight blade until...

Answer 29

2 years of age

Question 30

historically what type of tubes were used on children

Answer 30

only uncuffed up until 8 yrs

Question 31

Biggest risk factors of post-extubation laryngeal edema

Answer 31

Poorly fitted uncuffed ETTs | Repeat laryngoscopy

Question 32

Uncuffed: If no air leak heard at 20-25 cm H2O, ETT should be changed to

Answer 32

next half size smaller.

Question 33

minimal seal of cuffed tube?

Answer 33

20

Question 34

difference in microcuff and regular cuff ETT

Answer 34

Tracheal sealing at lower pressure (<15 cm H2O) shortened, more distal cuff no murphy eye

Question 35

disadvantages microcuff

Answer 35

expensive | can kink easily when warm

Question 36

how much size does cuff account for

Answer 36

.5 - thats why larger uncuffed can be used

Question 37

when can you start using cuffed ETT

Answer 37

3 kg!!

Question 38

what size cuffed tube should you use

Answer 38

: Use ½ size smaller than uncuffed size. Inflate to minimal seal at ≤ 20 cm H2O

Question 39

if you use nitrous during case with cuffed tube what precautions should you take

Answer 39

measure pressure every 10-15 mins for 2 hrs

Question 40

Approximate ETT Size <500 g

Answer 40

2.0 uncuffed

Question 41

Approximate ETT Size 500-1000gm

Answer 41

2.5 uncuffed

Question 42

Approximate ETT Size 1000-2500 gm

Answer 42

3.0 cuffed or uncuffed

Question 43

Approximate ETT Size term NB to 6 mo

Answer 43

3.0 cuffed

Question 44

Approximate ETT Size 6 mo - 1 year

Answer 44

3.5 cuffed

Question 45

Approximate ETT Size 1 yr - 18 months

Answer 45

4.0 cuffed

Question 46

Approximate ETT Size 18 mo - 2 years

Answer 46

4-4.5 cuffed

Question 47

>2 years formula for ETT size

Answer 47

age/4 + 3.5

Question 48

how to treat Post-extubation laryngeal edema/croup

Answer 48

Treat with steroids, nebulized racemic epinephrine, humidity

Question 49

90% of subglottic stenosis is caused by`

Answer 49

prolonged intubation or poorly fitted cuffed or uncuffed ETT

Question 50

Insertion Distance <1 kg

Answer 50

6 cm

Question 51

Insertion Distance <2 kg

Answer 51

9 cm

Question 52

Insertion Distance full term

Answer 52

10 cm

Question 53

Insertion Distance 1 yr

Answer 53

11 cm

Question 54

Insertion Distance 2 YR

Answer 54

12 cm

Question 55

Insertion Distance formula

Answer 55

age/2 + 12

Question 56

Peak inspiratory pressure must stay low to avoid what with lma use

Answer 56

abdominal insufflation/regurgitation.

Question 57

what is lma sizing based on

Answer 57

weight

Question 58

when should you give relaxant to peds?

Answer 58

when airway confirmed