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)
References and Links
CCC Airway Series
Emergencies: Can’t Intubate, Can’t Intubate, Can’t Oxygenate (CICO), Laryngospasm, Surgical Cricothyroidotomy
Conditions: Airway Obstruction, Airway in C-Spine Injury, Airway mgmt in major trauma, Airway in Maxillofacial Trauma, Airway in Neck Trauma, Angioedema, Coroner’s Clot, Intubation of the GI Bleeder, Intubation in GIH, Intubation, hypotension and shock, Peri-intubation life threats, Stridor, Post-Extubation Stridor, Tracheo-esophageal fistula, Trismus and Restricted Mouth Opening
Pre-Intubation: Airway Assessment, Apnoeic Oxygenation, Pre-oxygenation
Paediatric: Paediatric Airway, Paeds Anaesthetic Equipment, Upper airway obstruction in a child
Airway adjuncts: Intubating LMA, Laryngeal Mask Airway (LMA)
Intubation Aids: Bougie, Stylet, Airway Exchange Catheter
Intubation Pharmacology: Paralytics for intubation of the critically ill, Pre-treatment for RSI
Laryngoscopy: Bimanual laryngoscopy, Direct Laryngoscopy, Suction Assisted Laryngoscopy Airway Decontamination (SALAD), Three Axis Alignment vs Two Curve Theory, Video Laryngoscopy, Video Laryngoscopy vs. Direct
Intubation: Adverse effects of endotracheal intubation, Awake Intubation, Blind Digital Intubation, Cricoid Pressure, Delayed sequence intubation (DSI), Nasal intubation, Pre-hospital RSI, Rapid Sequence Intubation (RSI), RSI and PALM
Post-intubation: ETT Cuff Leak, Hypoxia, Post-intubation Care, Unplanned Extubation
Tracheostomy: Anatomy, Assessment of swallow, Bleeding trache, Complications, Insertion, Insertion timing, Literature summary, Perc. Trache, Perc. vs surgical trache, Respiratory distress in a trache patient, Trache Adv. and Disadv., Trache summary
Misc: Airway literature summaries, Bronchoscopic Anatomy, Cuff Leak Test, Difficult airway algorithms, Phases of Swallowing
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