CHAPTER 57 Pediatric Anesthesia
1 What are the differences between the adult and pediatric airways?
TABLE 57-1 Differences Between the Adult and Pediatric Airways
Infant Airway | Significance |
---|---|
Obligate nose breathers, narrow nares | Infants can breathe only through their noses, which can become easily obstructed by secretions. |
Large tongue | May obstruct airway and make laryngoscopy and intubation difficult. |
Large occiput | Sniffing position achieved with roll under shoulder. |
Glottis located at C3 in premature babies, C3-C4 in newborns, and C5 in adults | Larynx appears more anterior; cricoid pressure frequently helps with laryngeal visualization. |
Larynx and trachea are funnel shaped | Narrowest part of the trachea is at the vocal cords; the patient should have an ETT leak of <30 cm H2O to prevent excessive pressure on the tracheal mucosa, barotrauma. |
Vocal cords slant anteriorly | Insertion of ETT may be more difficult. |
ETT, Endotracheal tube.
2 Are there any differences in the adult and pediatric pulmonary systems?
TABLE 57-2 Differences in the Pediatric and Adult Pulmonary Systems
Pediatric Pulmonary System | Significance |
---|---|
Decreased, smaller alveoli | Thirteenfold growth in number of alveoli between birth and 6 years; threefold growth in size of alveoli between 6 years and adulthood |
Decreased compliance | Increased likelihood of airway collapse |
Increased airway resistance, vulnerability to smaller airways | Increased work of breathing and disease affecting small airways |
Horizontal ribs, pliable ribs and cartilage | Inefficient chest wall mechanics |
Less type 1, high-oxidative muscle | Babies tire more easily |
Decreased total lung capacity, faster respiratory and metabolic rate | Quicker desaturation |
Higher closing volumes | Increased dead-space ventilation |
3 How does the cardiovascular system differ in a child?


8 Describe the commonly used induction techniques in children




9 How does the presence of a left-to-right shunt affect inhalational induction and intravenous induction?
11 What other special precautions need to be taken in a child with heart disease?




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