Paediatric Anaesthetic Equipment
21/1/09
OHOA page 766-769
Oropharyngeal Airways
-
000 -> 4 (4-10cm in length)
not useful in neonates
measure; incisors to angle of jaw
don’t invert when inserting (damage to palate)
Nasopharyngeal Airways
- rarely used
- may be useful with some congenital airway problems or OSA
- measure; tip of nose -> tragus of ear
Facemasks
- round for neonates/infants
- tear drop for rest
- size appropriately
LMA
-
#1 < 6.5kg
#2 < 20kg
#3 < 30kg
#4 > 30kg
air = (size – 1) x 10mL
Laryngoscopes
- lengths 0-3
- curved or straight blade
Tracheal Tubes
- uncuffed until 8 years
- aim for leak @ 20cmH2O
-
<700g,
#2
<1200-1500g, #2.5
<3kg,
#3
term,
#3.5
Jeremy Fernando (2011)
- 6-12 months #4
- 1-2 years
#4.5
- >2 years
(age/4) + 4
- length @ lips = age/2 + 12
- length @ nose = age/2 +15
- confirm clinically
Anaesthetic Breathing Systems
AYRE’S T-PIECE WITH JACKSON REES MODIFICATION
- Mapleson F
- suitable from up to 20 kg
Advantages; low resistance, valveless, light weight, can assess TV, can, apply PEEP, potential for
assisted or controlled ventilation, qualitative appreciation of compliance, reduction in dead space
during SV, partial re-breathing allow conservation of heat and humidification.
Disadvantages; scavenging limited, FGF must be higher for SV than CV, ETCO2 may be
underestimated in children below 10 kg from dilution of expiratory gases
BAIN SYSTEM
- can only use above 20kg c/o resistance of expiratory valve
- co-axial
- Mapelson D system
CIRCLE ABSORPTION SYSTEM
-
most cost-efficient with low flows
reduces atmospheric pollution
conserves warmth and moisture
able to monitor inspiratory and expiratory gas concentrations
15mm circuit can be used in children 5 kg
during IPPV may need to increase FGF to compensate for leak
Mechanical Ventilation
- use childrens ventilator in kids <20kg
- pressure controlled ventilation reduces risk of barotraumas (this mode compensates for leak
around ETT)
- volume controlled ventilation allow monitoring of lung compliance
- Pinsp 16-20cmH2O, RR 16-24, PEEP 4
- hand ventilation with Ayre’s T-piece can be very helpful in certain circumstances (reduction of
gastroschisis or exomphalos or tracho-oesophageal fistula repair)
Jeremy Fernando (2011)