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)
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of three amazing children.
On Twitter, he is @precordialthump.
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