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4 Upper Airway Obstruction in Pediatric
4 Upper Airway Obstruction in Pediatric
No financial disclosures
No conflict of interest
Key points
Causes of airway obstruction in children
Management of laryngospasm
Anaphylactoid Rapidly
reactions progressive
Airway
obstruction Infections
Thermal injury
Airway
Trauma foreign body
Tachypnea
Paradoxical respiration “See-saw” pattern of breathing
(dyssynchrony between rib cage and abdomen)
Suprasternal, intercostal, and subcostal retraction along with
an increased use of accessory muscles of respiration
auto CPAP
Position: Infants may assume an opisthotonic position; the
"tripod" or sniffing position is seen in the older child
Stridor
airway compromise at
intrathoracic obstruction
the supraglotic or laryngeal level
Complications flexible
1. Mild oedema of the respiratory mucosa bronchoscopy
2. Tracheobronchitis
3. granulation tissue
flexible fiberoptic
intubation is difficult or bronchoscopy
impossible
If the condition of the child deteriorates,
cricothyrotomy and ventilation through
a T piece circuit can be considered
Even the dictum that ‘cuffed endotracheal tubes should not be used in
children under the age of 8 years’ can no longer be maintained
since the development of high-volume, low-pressure cuffs*
Endotracheal tube complications
incorrect size, traumatic or multiple intubations
up and down movements of the endotracheal tube
inadequate analgesia and sedation, whereby the infants
struggle while intubated
Controversial issue
Postoperative Tracheal
laryngospasm - life- extubation
threatening complication
aspiration, airway obstruction awake
deep anesthesia
Concern:light plane of anesthesia!
Yes No
Yes No
- Awake - Hypoxic (O2 saturation < 90 mmHg)
- Following commands - Excessively hyperbaric(Pa CO2 >50mm Hg
- Breathing spontaneuosly - Hypothermic (< 34 C)
- Wheel oxigenated - NMB present
- Not excessively hyperbaric
- (PaCo2 50 mmHg
- Fully recovered from MR
- Sustained head lift
- Strong hand grip
- Strong tongue protrusion
Partial laryngospasm
complete laryngospasm
inspiratory stridor
absence of air movement
Tracheal tug and paradoxical (“see-saw”) movement of the abdomen
This syndrome often presents as peaked T-waves and sudden cardiac arrest
within minutes after the administration of the drug in healthy appearing
children (usually, but not exclusively, males, and most frequently 8 years
of age or younger).
Airway irritation/obstruction
Blood/secretions
Light anaesthesia
Regurgitation
The main aim is to rapidly
oxygenate child!
100% oxygen (warm, humidified,
oxygen enriched air mixture in neonates)
Visualize and clear pharynx/airway
Jaw thrust with bilateral digital pressure behind
temporomandibular joint, oral/nasal airway
Deepen anaesthesia with propofol (20% induction dose)
Succinylcholine 0.5 mg/kg to relieve laryngospasm
(1.0-1.5 mg/kg i.v. or 4.0 mg/kg i.m. for intubation
Be aware of use in children < 2 years old!!!
Intubate and ventilate
Airway obstruction in the postoperative period
post-intubation croup
● Patients with possible UAO must never be sedated until the airway is
secured. Minimal sedation may precipitate acute respiratory failure