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) + 12

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

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