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Questions and Answers
What anatomical feature contributes to the pediatric airway's increased risk of obstruction?
What anatomical feature contributes to the pediatric airway's increased risk of obstruction?
What is the shape of the pediatric airflow path in comparison to adults?
What is the shape of the pediatric airflow path in comparison to adults?
Which characteristic of the pediatric epiglottis makes it different from an adult's?
Which characteristic of the pediatric epiglottis makes it different from an adult's?
What contributes to the increased resistance in pediatric airways?
What contributes to the increased resistance in pediatric airways?
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What causes decreased pulmonary vascular resistance (PVR) in pediatric patients? select 3
What causes decreased pulmonary vascular resistance (PVR) in pediatric patients? select 3
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What anatomical feature of the pediatric vocal cords is different from adults?
What anatomical feature of the pediatric vocal cords is different from adults?
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Why are infants more susceptible to hypoxemia?
Why are infants more susceptible to hypoxemia?
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Which factor would likely lead to increased PVR in pediatric patients? select all that apply
Which factor would likely lead to increased PVR in pediatric patients? select all that apply
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How does the metabolic rate of infants affect their ventilation?
How does the metabolic rate of infants affect their ventilation?
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What is a potential risk associated with using a nasopharyngeal airway (NPA) in pediatric patients?
What is a potential risk associated with using a nasopharyngeal airway (NPA) in pediatric patients?
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In which situation is laryngoscopy best performed using a Miller blade?
In which situation is laryngoscopy best performed using a Miller blade?
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Which of the following describes inspiratory stridor?
Which of the following describes inspiratory stridor?
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What factor can increase airway reactivity in children? select 2
What factor can increase airway reactivity in children? select 2
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Which statement best describes the position for mask ventilation in neonates?
Which statement best describes the position for mask ventilation in neonates?
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Which of the following conditions is characterized by cyanosis at rest that is relieved by crying due to blocked nasal passages?
Which of the following conditions is characterized by cyanosis at rest that is relieved by crying due to blocked nasal passages?
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What is a potential disadvantage of deep extubation compared to awake extubation? select 2
What is a potential disadvantage of deep extubation compared to awake extubation? select 2
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What does microtia indicate in terms of airway management?
What does microtia indicate in terms of airway management?
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Lack of muscle tone in the jaw and pharynx predisposes infants to _______
Lack of muscle tone in the jaw and pharynx predisposes infants to _______
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Where is the pediatric larynx located?
Where is the pediatric larynx located?
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What is the narrowest part of the pediatric airway?
What is the narrowest part of the pediatric airway?
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Which of the following statements accurately describes a unique feature of pediatric vocal cords compared to adult vocal cords?
Which of the following statements accurately describes a unique feature of pediatric vocal cords compared to adult vocal cords?
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Why is it easier to maintstem pediatric patients compared to adults?
Why is it easier to maintstem pediatric patients compared to adults?
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What is a characteristic of closing volume in pediatric patients?
What is a characteristic of closing volume in pediatric patients?
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What is the implication of Functional Residual Capacity (FRC) and Tidal Volume (Vt) being in a similar range in pediatric patients?
What is the implication of Functional Residual Capacity (FRC) and Tidal Volume (Vt) being in a similar range in pediatric patients?
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What is closing volume?
What is closing volume?
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Why is cardiac output (CO) dependent on heart rate (HR)? select 2
Why is cardiac output (CO) dependent on heart rate (HR)? select 2
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How long do patients typically experience increased airway reactivity after a Upper Respiratory Infection (URI)?
How long do patients typically experience increased airway reactivity after a Upper Respiratory Infection (URI)?
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History of croup, stridor, or traumatic/prolonged intubations can indicate which of the following?
History of croup, stridor, or traumatic/prolonged intubations can indicate which of the following?
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What recurrent condition can indicate frequent aspiration?
What recurrent condition can indicate frequent aspiration?
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NPAs are typically avoided in pediatric patients due to trauma and bleeding from hypertrophied adenoids
NPAs are typically avoided in pediatric patients due to trauma and bleeding from hypertrophied adenoids
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What complication can occur from inserting an oral airway during stage 2 of anesthesia?
What complication can occur from inserting an oral airway during stage 2 of anesthesia?
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When are laryngeal mask airways (LMAs) contraindicated?
When are laryngeal mask airways (LMAs) contraindicated?
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What additional equipment should be available during a mask ventilation case? select all that apply
What additional equipment should be available during a mask ventilation case? select all that apply
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ETT sizing
Cuffed = age/4+3.5
Uncuffed = age/4+4
ETT depth = 3x diameter of ETT
ETT sizing Cuffed = age/4+3.5 Uncuffed = age/4+4 ETT depth = 3x diameter of ETT
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At what pressure should a cuff leak be present in pediatric patients?
At what pressure should a cuff leak be present in pediatric patients?
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Why is the sniffing position disadvantageous in smaller pediatric patients?
Why is the sniffing position disadvantageous in smaller pediatric patients?
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When is a MAC blade recommended for intubation in pediatric patients?
When is a MAC blade recommended for intubation in pediatric patients?
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What is the preferred ventilation mode for pediatric patients?
What is the preferred ventilation mode for pediatric patients?
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Until what gestational age is there a risk of retinopathy of prematurity associated with oxygen use?
Until what gestational age is there a risk of retinopathy of prematurity associated with oxygen use?
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What does an expiratory stridor indicate?
What does an expiratory stridor indicate?
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What does hoarseness indicate in relation to airway obstruction?
What does hoarseness indicate in relation to airway obstruction?
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Which of the following characteristics of Down syndrome are associated with difficult airway management? (Select all that apply)
Which of the following characteristics of Down syndrome are associated with difficult airway management? (Select all that apply)
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What is glossoptosis?
What is glossoptosis?
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________ is associated with difficult intubation regardless of the cause.
________ is associated with difficult intubation regardless of the cause.
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Study Notes
Pediatric Airway Anatomy
- Pediatric head is proportionally larger than the rest of the body compared to adults
- Nose is smaller compared to the trachea in infants, who are obligate nose breathers at birth
- Tongue is larger in proportion to mouth size in children, potentially obstructing the airway
Airway Differences
- Airway shape is funnel-shaped in pediatrics, becoming cone-shaped in adults later in development
- Larynx is higher relative to the c-spine in children than adults, located at C3-C4
- Vocal cords in children attach lower on the anterior trachea than in adults, and slant forward and down
- Cricoid cartilage is the narrowest part of the pediatric airway, and the epiglottis has an omega shape in children, which is larger and stiffer than in adults
Infant Airway Considerations
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Miller blades are recommended for direct lifting of the epiglottis in infants
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Mainstem bronchi are narrower and shorter in infants compared to adults
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Mainstem bronchi divide more equally
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Infant airways are smaller in diameter, resulting in higher airway resistance
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Infants show a lower tolerance to edema , high metabolic rate, and decreased response to hypercapnia if ventilation increases
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Comparison of respiratory parameters:
- Infant FRC is half of TLC
- Infant RR is 25-50
- Infant Vt is 6-8 ml/kg
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Pediatric closing volume is higher than in adults
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Pediatric FRC is closer to Vt, meaning smaller range of optimal oxygenation
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Pediatric oxygenation can decrease faster
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In infants, several factors including hypoxia, hypercarbia, acidosis, and high Hct can increase pulmonary vascular resistance (PVR)
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Similar factors in adults cause the opposite effect, decreasing PVR
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CO depends on heart rate (HR) due to fixed stroke volume (SV)
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Airway evaluation should consider recurrent pneumonia/respiratory infections as a possible indicator of frequent aspiration, and also note pre-existing conditions
Aspiration and Airway Issues
- Aspiration can occur due to incompetent larynx, GERD, TEF (tracheo-esophageal fistula), and tracheobronchial fistula
- Presence of URI can increase the risk of airway edema and associated conditions.
- Environmental factors, such as allergies or secondhand smoke, can exacerbate airway reactivity
- Conditions such as microtia (deformed ears), can cause increased risk of difficult airway management
- Positioning during mask ventilation of neonates should maintain normal head and neck alignment, however neck extension can be performed in older pediatric cases
- Nasopharyngeal airways (NPAs) are typically avoided in children due to increased risk of trauma due to hypertrophied adenoids
- Oral airway placement should account for tongue size, which is larger relative to the oropharynx in children, which will cause a block to airway flow
- The insertion of a mask can cause laryngospasm if performed during stage 2 (insertion)
- Minimizing pressure during mask ventilation is crucial to prevent airway collapse
- Laryngospasm needs careful assessment to determine whether to use LMA or Intubation
- Other airway issues include conditions like atlantoaxial instability (with or without subluxation), hypoplastic mandible, protruding tongue, Pierre-Robin sequence, and Treacher-Collins syndrome
Ventilation and Intubation Considerations
- Physiologic PEEP is 4-5
- Avoiding oxygen/N2O before 44 weeks of age to mitigate retinopathy of prematurity
- Extubation can be performed in an awake or deep state and have different advantages or disadvantages based on preference
- Considerations should be given to patient condition if non-protected airway is needed, as a non-protected airway puts patient in greater risk for aspiration
- Different airway obstruction causes can arise based on location (above vs below larynx), and may affect respiratory sounds
- Difficult procedures need well-considered use of airway devices to avoid possible complications
- Various airway syndromes such as choanal atresia and clef lip/palate can all result in a need for airway intervention
Additional Considerations
- Proper cuff pressure (20 cmH2O) and proper size consideration for endotracheal intubation (ETT) are critical
- Use of an appropriate intubation technique ( Miller or MAC) is essential depending on age range of patient
- Nasally intubation is preferable if possible, and using PCP mode if needed
- Consider physiological PEEP to assist with ventilation
- Avoid unnecessary instrumentation and procedures in the nasal cavity
- Various congenital conditions can affect the airway, requiring earlier consideration/preparation
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Description
Explore the unique features of pediatric airway anatomy in this quiz. Understand the structural differences between children and adults, including the implications for airway management. This knowledge is essential for medical professionals working with infants and children.
