TY - CHAP
T1 - Extubation in children with difficult airways
AU - Sequera-Ramos, Luis
AU - Zhu, Alec
AU - Kiesel, Benjamin
AU - Jagannathan, Narasimhan
N1 - Publisher Copyright:
© Cambridge University Press 2020.
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2019/9/10
Y1 - 2019/9/10
N2 - There are some unique considerations when caring for the airway in infants and small children. They have relatively larger oropharyngeal structures (tongue, tonsils, and adenoids), and a large and floppy epiglottis, which can predispose to upper airway obstruction. A larger occiput may increase the neck flexion observed while in supine position as compared with adults, which can also lead to airway obstruction. The shorter and narrower trachea may increase the risk for tracheal tube malposition after intubation, and has a greater risk for secretions, edema, or foreign body to produce disproportionate negative effects in airflow resistance. Children run the highest risk of problems from stridor and glottic edema because of their smaller diameter airways. Post-extubation stridor incidence ranges from 2% in children having elective surgical procedures to 40% in pediatric trauma and burn victims. Additionally, infants have less physical space in the oropharynx and within the tracheal tube for an advanced bridging technique such as SGA devices and/or airway exchange catheter.
AB - There are some unique considerations when caring for the airway in infants and small children. They have relatively larger oropharyngeal structures (tongue, tonsils, and adenoids), and a large and floppy epiglottis, which can predispose to upper airway obstruction. A larger occiput may increase the neck flexion observed while in supine position as compared with adults, which can also lead to airway obstruction. The shorter and narrower trachea may increase the risk for tracheal tube malposition after intubation, and has a greater risk for secretions, edema, or foreign body to produce disproportionate negative effects in airflow resistance. Children run the highest risk of problems from stridor and glottic edema because of their smaller diameter airways. Post-extubation stridor incidence ranges from 2% in children having elective surgical procedures to 40% in pediatric trauma and burn victims. Additionally, infants have less physical space in the oropharynx and within the tracheal tube for an advanced bridging technique such as SGA devices and/or airway exchange catheter.
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U2 - 10.1017/9781316658680.016
DO - 10.1017/9781316658680.016
M3 - Chapter
AN - SCOPUS:85097706308
SN - 9781108492584
SP - 161
EP - 168
BT - Management of the Difficult Pediatric Airway
PB - Cambridge University Press
ER -