Laryngoscopy and Airway Devices in Pediatric Anesthesia:
Pediatric Positioning for Laryngoscopy
Refer to the differences between the pediatric and adult airway as described here.
- An infant’s large occiput results in C-spine flexion when supine therefore padding under the shoulders is needed to optimize "sniffing position".
Straight vs Curved Blades
- The straight blades (e.g. Miller or Wisconsin) are designed for lifting the epiglottis out of view in young children.
ETT Size and Insertion Depth
Between the ages of 2 to 8 years the following formula can be used to calculate the uncuffed ETT size:
- Uncuffed ETT size in mm = (age in years/4) + 4
- Cuffed ETT size is 0.5mm smaller than uncuffed ETT
Beyond one year of age, the ETT depth may be estimated by the formula:
- ETT depth cm = (age in years/2) + 1
Laryngeal Mask Airway
- Useful in unexpected difficult airway though does not protect against laryngospasm or aspiration.
- LMA sizes are based on patient weight. Est weight = Age x 2 + 9
Next page: Problems Encountered in Pediatric Airway Management