0071643192.pdf

■ Difficult cricothyrotomy
■ Predictors include: Short/obese neck, prior surgery or radiation, presence
of mass or hematoma.

PEDIATRICVERSUSADULTANATOMY

Besides the obvious smaller size of the pediatric airway, there are other
important anatomic differences compared to the adult airway (see Table 1.2).
These differences gradually decrease with age. Adult proportions are seen at
8–10 years.

AIRWAYEQUIPMENT

ENDOTRACHEAL(ET) TUBE

■ Adult male: 7.5–9.0 mm tube
■ Adult female: 7.0–8.0 mm tube
■ Pediatrics: (4 +age in years)/4
■ Traditional practice is to use uncuffed tube if <8 years old.
■ Nasal intubation: Use slightly smaller tube (by 0.5–1.0 mm).

LARYNGOSCOPEBLADES

■ MacIntosh
■ Curved, fits into the vallecula
■ Indirectly lifts the epiglottis via the hypoepiglottic ligament
■ Miller
■ Straight, goes under the epiglottis to lift it directly
■ Preferred in pediatric patients (especially <3 years old) or if larynx is
fixed by scar tissue

RESUSCITATION

TABLE 1.2. Differences Found in Pediatric Versus Adult Anatomy

VARIABLE PEDIATRICANATOMY EFFECT

Size of occiput Larger Flexed neck when supine,

obstructing airway

Smallest airway At cricoid ring ET tube may pass through cords

diameter (vs vocal cords in adult) but go no further

Larynx More superior and anterior Better visualized with straight blade

Epiglottis Larger and floppy Best displaced with straight blade

Tongue Larger ↑Risk of obstruction

Length of trachea Infant = 5 cm Depth at teeth = 3 ×the

18 month = 7 cm ET tube size or

(vs adult = 12 cm) (0.5 ×age [yrs]) + 12

The narrowest part of the

adult airway = vocal cords.

The narrowest part of the

pediatric airway = cricoid ring.

The MacIntosh blade

indirectly lifts the epiglottis via

the hypoepiglottic ligament.

Elevating the child’s torso with

blankets will correct for the

larger occiput and the more

anterior anatomy, making

visualization easier.