1. Paediatric Airways

2. Upper Airway Anatomy • Large head • Large tongue • High anterior larynx • Infant epiglottis long, floppy & U shaped • Funnel shaped larynx • Narrow trachea

3. Airway Differences

7. Respiratory Physiology • Not mature until 8 years • Deadspace volume very small • Higher airflow resistance • Higher chest wall compliance • Higher ventilation-perfusion mismatch • Higher oxygen consumption for weight • Infant diaphragms lack slow muscle fibres • Decreased respiratory reserve

8. Area difference = 12 fold prior to pathology Flow difference = 120 fold prior to pathology Flow  r 4 = 400 fold following pathology

9. Down Syndrome • Relatively large tongue • Small mandible • Possible Cx spine instability • OSA is common • Possibly smaller ETT • Difficult intubation

10. Pierre Robin Syndrome

11. URTI • Bronchospasm • Mucous plugging • ? Early pneumonia • Laryngospasm • Stridor • Cough

12. Tracheal Intubation • Airway protection • Facilitates access to shared airway • Muscle relaxation • Improve efficiency of ventilation • Long procedures

13. ETT • Diameter • Oral ETT age/4 + 4 • Neonate 3.0-3.5mm • Nasal under 6 years same, over 6 years half to one size smaller • Length • Oral ETT age/2 + 12 • Nasal ETT age/2 + 15

14. Cuffed ETT ? • Postintubation croup? • Recent studies little difference • 2-3% cuffed or uncuffed post surgery • 15% cuffed or uncuffed post PICU • Less need to replace tube • Better airway protection ? relevance • No gas leak – good for staff and IPPV • Smaller diameter tube – higher resistance

15. LMA • As a face mask alternative • Not with potential full stomach • Possible for some dental/ENT work with minimal expected soiling • Anaesthetist preference

16. Face Masks

17. Laryngeal Spasm • Avoid • CPAP & Oxygen • Clear airway judiciously • Deepen anaesthesia • Topical lignocaine • Very low dose Sux (¼ usual) • Intubate/reintubate if needed

18. Difficult Intubation • AVOID • Refer to tertiary centre if possible • Spontaneous ventilation gas induction • Then???

19. Shikani