Treatment of a Pediatric Airway while under Anaesthetized

Jaclin Perck^*
*Correspondence: Jaclin Perck, Department of Paediatrics, Division of Respiratory Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland, Email:

Short Communication..

The anaesthesiologist’s job includes securing an airway. When compared to adults, juvenile patients have substantial anatomical and physiological variations, which have an impact on the techniques and instruments that an anaesthesiologist may use to ensure safe and effective airway management. Furthermore, there are a variety of clinical disorders that exhibit distinct anatomical or functional challenges in airway control, which are most commonly found in children. A "difficult airway" can be predicted if one of these syndromes or diseases is present. There are several gadgets and technologies on the market now that are meant to help with airway control. Some have been adapted from adult designs, but many require method adjustments to accommodate for the anatomical and physiological variations of juvenile patients. This review focuses on paediatric airway examination and care, as well as the special issues that these patients face [1].

The control of the airway is one of an anaesthesiologist’s most important abilities. It is critical for the provider to understand the important anatomical, physiological, and pathological aspects of the airway, as well as the numerous instruments and procedures that have been created for this purpose, in order to be effective at this role. In this vein, the majority of anaesthesia practitioners are quite familiar with and proficient at properly controlling the adult airway. Children, on the other hand, are not just miniature grownups. During development, significant changes arise that necessitate a distinct method or technique [2]. If you're forewarned, you're forearmed. As a result, the focus of this review paper will be on some of the most significant anatomical and physiological distinctions, as well as their implications. It will next go through some of the pathological diseases that are of special concern when it comes to airway management. Finally, an overview of paediatric airway management strategies and instruments will be given [3-5].

The most basic airway management

• The goal of airway management is to predict and detect respiratory difficulties, as well as to sustain or replace those that have become damaged or lost their function.

• A person must be able to support three different things functions:

1. Keep their airway clear.

2. Ascertain that the space is adequately ventilated.

3. Make sure you're getting enough oxygen.

• If you don't do one, you'll end up with respiratory failure.

Advance life support for children and adolescents

Positioning:

• By separating the tongue from the posterior pharyngeal structures, the chin lift and jaw push can assist restore flow through a clogged upper airway.

• The objective is to align three divergent axes: the oral, pharyngeal, and tracheal axes.

Adjuvants for the airway:

Oropharyngeal Airways are a kind of oropharyngeal airway:

• Makes it easier to get rid of upper airway blockage caused by a big tongue.

• Suctioning of the oropharynx is possible.

• Prevents biting from compressing a child's endotracheal tube.

Airways of the Nasopharynx:

• From the Nostril to the Tragus

• Indications and Contraindications:

• Fracture of the basilar skull

• Leakage of CSF

• Coagulopathay Bag-Valve-Mask

• Masks should be able to slip over the nose and mouth without putting any strain on the eyes.

• Valves allow unidirectional oxygen delivery to the patient while preventing entrainment of exhaled waste gas into the system.

• Agitation

• Retractions

• Access muscles

• Wheezing

• Sweating

• Prolonged Expiration

• Pulsus paradoxus

• Apnea

• Cyanosis

• Tachypnea

• Tachycardia

• Grunting

• Stridor

• Head bobbing

• Flaring

• Inability to lie down

Intubation:

When Is It Necessary?

1. PaO₂ at 60 mmHg, FiO₂ of 0.6 (no congenital heart disease)

2. PaCO₂ >50 mmHg (acute/refractory to previous treatments)

3. Obstruction of the upper airway

4. Neuromuscular weakness (NIF -20, vital capacity 12-15 ml/kg

5. Protective airway reflexes are absent (cough, gag)

6. Hemodynamic instability

7. Hyperventilation for therapeutic purposes (TBI)

8. Toilet for the lungs

9. Administering emergency medications

Intubation can be used for a variety of reasons: Recognize the neurological indications for intubation:

• Child who has taken a CNS depressant

• Loss of airway protective reflexes

• Recognize that intubation may be necessary despite excellent respiratory function,

• Head trauma or high ICP

• Recognize that intubation may be necessary prior to the onset of respiratory failure in patients with muscle weakness

• Recognize that intubation may be necessary prior to the onset of respiratory failure in patients with muscle weakness in patients with muscle

Anaesthesiologists must be able to control their patients' airways. When compared to an adult's airway, a young patient's airway has a number of major variations and provides some distinct issues. The anaesthesiologist will be able to create and execute safe and effective paediatric airway management by understanding anatomical and physiological distinctions, essential clinical disorders affecting children, and current airway methods and instruments.

References

1. https://strac.org/files/Education/2018_conference/Presentations/Pedi_Dr_Daniel_Gebbhard_Pediatric_Airway_Presentation.pdf
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3982373/
3. Heinrich, Sebastian, Torsten Birkholz, Harald Ihmsen, and Andrea Irouschek, et al. “Incidence and predictors of difficult laryngoscopy in 11,219 pediatric anesthesia procedures.” Paediatr Anaesth. 22(2012): 729–736.
4. Carr RJ, DS Beebe, and KG Belani. “The difficult pediatric airway.” Sem Anesth Perioper Med Pain. 20(2001): 219–227.
5. Sunder, Rani A, Dawit T Haile, Patrick T Farrell, and Anshuman Sharma. “Pediatric airway management: Current practices and future directions.” Paediatr Anaesth. 22(2012): 1008–1015.