The document provides an overview of pediatric airway anatomy, physiology, and management. It discusses the differences between pediatric and adult airways, including a more rostral larynx, relatively larger tongue, angled vocal cords, differently shaped epiglottis, and funneled larynx in children. It also reviews normal airway management techniques like bag-mask ventilation and various airway devices, as well as complications from intubation. The goal is to protect, adequately ventilate, and oxygenate the pediatric airway.

1. Basics of Pediatric Airway Anatomy, Physiology and Management Christine Mai, MD Claudine Mansour, MD Faculty Advisor: Ruth Padilla, MD Boston University Medical Center Department of Anesthesiology

7. More rostral pediatric larynx Laryngeal apparatus develops from brachial clefts and descends caudally Infant’s larynx is higher in neck (C2-3) compared to adult’s (C4-5) Larynx C4-5 Larynx C2-3 Image from: http://depts.washington.edu/pccm/Pediatric%20Airway%20management.ppt

13. Physiology: Effect Of Edema Poiseuille’s law R = 8nl/ π r 4 If radius is halved, resistance increases 16 x Image from: http://www.hadassah.org.il/NR/rdonlyres/59B531BD-EECC-4FOE-9E81-14B9B29D139B1945/AirwayManagement.ppt

14. Normal Inspiration and Expiration turbulence Inspiration Expiration Image from: http://www.hadassah.org.il/NR/rdonlyres/59B531BD-EECC-4FOE-9E81-14B9B29D139B1945/AirwayManagement.ppt

15. Obstructed Airways turbulence & wheezing Extrathoracic Upper Airway Obstruction Intrathoracic Lower Airway Obstruction Epiglottitis, laryngotracheobronchitis, foreign body Asthma, bronchiolitis Image from: http://www.hadassah.org.il/NR/rdonlyres/59B531BD-EECC-4FOE-9E81-14B9B29D139B1945/AirwayManagement.ppt

22. Oropharyngeal Airway SIZE PROPER POSITION Image from: http://www.hadassah.org.il/NR/rdonlyres/59B531BD-EECC-4FOE-9E81-14B9B29D139B1945/AirwayManagement.ppt

23. Oropharyngeal Airway Placement Wrong size: Too long Correct Size Wrong size: Too short Image from: http://depts.Washington.edu/pccm/Pediatric%20Airway%20management.ppt

27. Endotracheal Tube New AHA Formulas: Uncuffed ETT: (age in years/4) + 4 Cuffed ETT: (age in years/4) +3 ETT depth (lip): ETT size x 3 Age Wt ETT(mm ID) Length(cm ) Preterm 1 kg 2.5 6 1-2.5 kg 3.0 7-9 Neonate-6mo 3.0-3.5 10 6 mo-1 3.5-4.0 11 1-2 yrs 4.0-5.0 12

43. Pediatric Difficult Airway Algorithm Rigid bronchoscopy The unexpected difficult pediatric intubation Mask ventilation possible? Succeed Non emergency pathway If mask ventilation becomes inadequate Fail Emergency Pathway Call for help Awaken patient Succeed Succeed Failed Failed Awaken patient Establish definitive airway Surgical airway GA by mask GA by LMA Surgical airway Surgical airway Awake intubation technique Regional anesthesia Abort and regroup Persue other intubation options Change head position Different intubation technique Different technique with rigid laryngoscope LMA as intubation guide Fiberoptic Light wand Retrograde OELM Different blades Stylets Retromolar approach Persue emergency oxygenation/ventilation options Two person mask ventilation Percutaneous cricothyrotomy LMA