Outline the important anatomic features that affect airway management in the paediatric airway and, where appropriate, strategies that may be used to overcome these.
Answer and interpretation
- Prominent occiput – Causes some neck flexion in the supine position. This can interfere with attempts to visualize the glottic opening during laryngoscopy. Placing a towel roll under the shoulders can improve airway alignment.
- Large tongue – Infants and young children have large tongues relative to the size of the oral cavity. Can cause airway obstruction and interfere with laryngoscopy.
- Larger tonsils and adenoids – Can cause airway obstruction. Placement of nasal airway may cause bleeding and aspiration.
- Superior laryngeal position – located opposite the C3 to C4 vertebrae, compared with the C4 to C5 in adults. Visualization of glottis more challenging.
- Large, floppy epiglottis – the epiglottis projects into the airway and covers more of the glottis. A straight blade needed to directly lift the epiglottis for improved visualisation during direct laryngoscopy.
- Short trachea – The short trachea predisposes to right endobronchial intubation or inadvertent extubation. Use of formula (age/2 +12 cm from lower lip) to estimate tube length. Special attention to fixation.
- Narrow trachea – Small decreases in the airway size from secretions, oedema, or external compression will cause obstruction. The needle or surgical cricothyroidotomy technically challenging in infants and children. (0.5)
- Anatomic subglottic narrowing – this narrowing can create an effective anatomic seal without the need for a cuffed ETT. Foreign bodies can become lodged below the cords.