Paediatric Anaesthetic Equipment

AIRWAY ADJUNCTS

Oropharyngeal Airways

  • 000 -> 4 (4-10cm in length)
  • not useful in neonates
  • measure; incisors to angle of jaw
  • don’t invert when inserting (damage to palate)

Nasopharyngeal Airways

  • rarely used
  • may be useful with some congenital airway problems or OSA
  • measure; tip of nose -> tragus of ear

Facemasks

  • round for neonates/infants
  • tear drop for rest
  • size appropriately

LMA

  • #1 < 6.5kg
  • #2 < 20kg
  • #3 < 30kg
  • #4 > 30kg
  • air = (size – 1) x 10mL

INTUBATION EQUIPMENT

Laryngoscopes

  • lengths 0-3
  • curved or straight blade

Tracheal Tubes

  • traditionally uncuffed until 8 years (cuffed tubes now wdiely used)
  • aim for leak @ 20cmH2O
  • <700g, #2
  • <1200-1500g, #2.5
  • <3kg, #3 – term, #3.5 – 6-12 months #4 – 1-2 years #4.5 – >2 years (age/4) + 4
  • length @ lips = age/2 + 12
  • length @ nose = age/2 +15
  • confirm clinically

ANAESTHETIC BREATHING SYSTEMS

AYRE’S T-PIECE WITH JACKSON REES MODIFICATION

  • sometimes known as the Mapleson F system
  • suitable from up to 20 kg
  • Advantages — low resistance, valveless, light weight, can assess TV, can, apply PEEP, potential for assisted or controlled ventilation, qualitative appreciation of compliance, reduction in dead space during SV, partial re-breathing allow conservation of heat and humidification.
  • Disadvantages — scavenging limited, FGF must be higher for SV than CV, ETCO2 may be underestimated in children below 10 kg from dilution of expiratory gases

BAIN SYSTEM

  • can only use above 20kg c/o resistance of expiratory valve
  • co-axial
  • Mapelson D system

CIRCLE ABSORPTION SYSTEM

  • most cost-efficient with low flows
  • reduces atmospheric pollution
  • conserves warmth and moisture
  • able to monitor inspiratory and expiratory gas concentrations
  • 15mm circuit can be used in children 5 kg
  • during IPPV may need to increase FGF (free gas flow) to compensate for leak

Mechanical Ventilation

  • use childrens ventilator in kids <20kg
  • pressure controlled ventilation reduces risk of barotraumas (this mode compensates for leak around ETT)
  • volume controlled ventilation allow monitoring of lung compliance
  • Pinsp 16-20cmH2O, RR 16-24, PEEP 4
  • hand ventilation with Ayre’s T-piece can be very helpful in certain circumstances (reduction of gastroschisis or exomphalos or tracho-oesophageal fistula repair)

CCC Airway Series

Critical Care

Compendium

Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the  Clinician Educator Incubator programme, and a CICM First Part Examiner.

He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.

His one great achievement is being the father of three amazing children.

On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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