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Airway Management in Children

  • Britta von Ungern-SternbergEmail author
  • Craig Sims
Chapter

Abstract

The potential difficulties in airway management in children discourage many anesthetists from caring for children in their practice. Airway management must be adapted to anatomical changes and variation in patient size, and the anesthetist must have skills to quickly establish ventilation because children desaturate quickly during apnea. For these reasons, airway and respiratory complications are the commonest cause of morbidity and mortality in children without cardiac malformations. Facemask ventilation is the most important skill to learn during training, along with continuous positive airway pressure support (CPAP). The LMA has become very popular for use in children because it frees up the anesthetist’s hands, while avoiding intubation of the frequently irritable tracheobronchial tree. While many new supraglottic airway devices are available in pediatric sizes, none is consistently superior to the LMA. The cuffed ETT has become standard practice, but there are important differences in design between manufacturers. The videolaryngoscope is useful for routine intubation of infants, and is a better choice than the direct laryngoscope in children with an expected difficult airway. Laryngospasm occurs from time to time in pediatric anesthesia, and needs to be managed quickly and effectively. Although deepening anesthesia with propofol is a useful early strategy, suxamethonium remains the best treatment once hypoxia has developed. Children can have difficult airways for many reasons. Difficult ventilation and intubation are managed following similar paths to adults. Infants with difficult airways are at high risk from complications and need care in a specialist center.

Keywords

Upper airway, child Upper airway obstruction in pediatric anesthesia Pediatric endotracheal tube Supraglottic airways in children Pediatric difficult airway Laryngospasm, management Cuffed tracheal tubes for children 

Further Rewading

Anatomy and General Management

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Laryngospasm

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Difficult Airway

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CICO

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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of Anaesthesia and Pain ManagementPerth Children’s HospitalNedlandsAustralia
  2. 2.Medical School, The University of Western AustraliaPerthAustralia

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