00:00
These are the supplies that you need,
the basic supplies you need to secure
the pediatric airway. And the first thing you should notice
is that none of these endotracheal tubes have a cuff on them.
00:11
These tubes are made to fit at the cricoid
level reasonably snugly, so that there's
no leak. You don't want to inflate a cuff
at that level, because the pressure
on the cricoid can damage the laryngeal
mucosa and actually lead to the development
of tracheal stenosis. So these tubes are
not cuffed like they are in an adult. And you can see
the various sizes from quite small to somewhat
larger, and at the very bottom you see a tube that's
a rather funny shaped tube, it's got about a 30 degree
angle in it, and the distal part of the tube
is small and there's kind of
a ridge about 2/3 of the way down
the tube. That ridge goes right
at the incisor teeth in a newborn and the distal part of the tube
goes down through the cords, and it's supposed
to help the tube stabilize. It doesn't very well,
so you still have to tape it in or secure it
in some way. But that was the original thought
when it was developed.
01:15
The use of cuffed endotracheal tubes
in the pediatric
population is growing in popularity.
01:20
Recent studies show that
post-operative strider and other airway
complications are not associated
with a cuffed tube, as previously thought.
01:26
These are typical pediatric
laryngoscopes. And you'll notice that even the biggest
of these, which would be used in a, probably in
a child up to about 8 or 9 years of age, is not
as curved as the Macintosh blade that's
used in adults. And the other blades, many
of the blades are straight blades. The Miller blade,
the straight blade, is much more commonly used
in children than in adults because that epiglottis is so stiff
and difficult to deal with. You actually try to put the blade
under the epiglottis and lift the epiglottis, whereas
in adults you put it in front of the epiglottis
and lift the tongue. And it's
the tongue that lifts the epiglottis. That doesn't
happen predictably in small children.
02:11
So here's a child being intubated. The usual
mask, bag and masking at the beginning.
02:17
You can see that the laryngoscope handle is much smaller
than in an adult. That's just to make it easier to manage
and balance it better. And the anesthesiologist
is passing a tube. The tube is
at the point that the anesthesiologist is happy with,
in the fourth picture, and they will secure the tube
at that point and then take over the child's breathing
for them.