Paediatric Airway Management

If maintaining airway and awake:

• Do not look in the throat (best done in theatre under GA)
• Allow patient to find most comfortable position i.e. in mum's lap
• Semi-emergent gaseous induction in theatre

If completely obstructed:

• Suction
• Immediately bag mask ventilate with CPAP
  • Black bag with Ayre's T-piece (preferable)
  • Black bag with PEEP valve
  • Self-inflating bag (Laerdal) with PEEP valve
• Intubate (needs experienced operator)
  • Use ETT one size smaller (ETT size (mm) = 4 + age/4)
  • Consider using 'Croup' tubes - small diameter conventional ETT tubes may be too short
  • In epiglottitis - cords may be obscured by inflamed epiglottis - pass the tube 'between the buttocks')
  • If unable to visualise cords, lateral chest compression may produce air bubbles at the laryngeal inlet
• Needle cricothyroidotomy (not surgical if < 8yo)
  • Insert 18G needle
  • Have assistant to stabilise needle
  • Attach oxygen tubing with a side hole cut in side - connect to wall source 15L/min
  • Ventilate 1sec in:3 sec out