Paediatric Anaesthetic Equipment

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

- 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)