Pediatric Airway Management andPediatric Life Support - Essay Example

Pediatric Airway Management Name Institution Pediatric Life Support A healthy mind has an easy breath. Keeping the respiratory system safe is a significant role for the anesthesiologist. The human airway is a set of organs which function by taking in oxygen and carbon dioxide expulsion. The respiratory system is divided into two: the upper airway and the lower airway. The upper respiratory tract comprises of the mouth, nose, sinuses, and the throat. On the other hand, the lower respiratory tract is composed of the trachea, brachial system, and the lungs which happen to be primary organs (Isono, 2006). Head and neck structure forms a highly specialized part of the body. The structures inside are compacted into a small, complex area thereby making them closely interrelated. The head and neck indicate the initial part of oxygen entry into the body. The setup begins at the mouth and nose where inhalation of oxygen begins, therefore, allowing for respiration. The essential parts of the airway system in the head and neck are the nasal cavity which is connected to the pharynx and aids in maintaining airflow as it heads to the lungs. The pharynx is also an important part of the respiratory and digestive systems. It is also known as throat in Greek, is a passageway shaped like a cone connecting from the nasal and oral cavities in the head to the larynx and esophagus. Pharynx chamber has two functions: digestive and respiratory functions. It is attached to the base of the skull by thick muscle fibers and connective tissues. It is on the sides and behind the voice box which is a part of a tube that carries air into and from the lungs and accommodates the epiglottis. The epiglottis is upright at rest and allows entry of air into the larynx and the whole respiratory structure (Carron et al., 2000). The throat has circular and longitudinal muscles, the circular muscles function by preventing ingestion of air by constricting thereby pushing food into the esophagus whereas, the longitudinal muscles contract the pharyngeal walls during swallowing. Moreover, the pharynx is composed of three major divisions (Sagarin & Chiang, 2002 ). The nasal pharynx is the anterior portion, and it is the back part of the nasal cavity. Through the isthmus, the oral pharynx connects to the nasal cavity. The third region is the laryngeal pharynx between the epiglottis and the esophagus. Its function is to maintain air passage to the lungs and food entry through the esophagus (Brambrink et al., 2002). The pediatric patients have critical anatomical and physiological contrasts compared to adults, which affect on the procedures and tools that the anesthesiologist may choose an effective control method for the respiratory system. Furthermore, in the pediatric population, many morbid processes are seen. These conditions present functional difficulties in the management of respiratory system management. Even though these circumstances can forecast a difficult respiration disorder, many devices and instruments are currently present, and they have been designed to aid in respiratory system management. One of Anesthesiologists fundamental skills is the management of respiratory systems, so it is important to have knowledge of the physiological, anatomical, and pathological features which are related to the respiratory system (Goldmann et al., 2006). Differences of Head and Neck Structure between Pediatric and Adults The Childs occiput is large compared to an adult, therefore, can compromise the respiratory system. Further, on laying supine, which is commonly considered as a natural position, there is flexion of the neck predisposing to an obstruction or partial obstruction of the airway. Snoring or obstructed respiratory pattern, possibly with stridor will be indicative of airway obstruction and will be due to flexed position in a pediatric patient. An essential intervention will be to place behind the shoulders, a small roll formed from a small flannel sheet so as to maintain the neutrality of the respiratory system and patency of the respiratory airway in the pediatric and neonatal patient. Also, folding two face clothes simultaneously quarters and placing them evenly and directly behind upper thorax and the shoulders. This intervention will be adequate to raise the thorax and shift the occiput back. Importantly, the goal is to maintain the airway in a neutral position not either in extension or flexion. The “sniffing” position which is common in adults can also work well in pediatric cases. Checking the sniffing position is by aligning the anterior shoulder and the external auditory canal for best airway canal alignment. Alternatively, insert a laryngoscope into the mouth of the patient slowly and this method is termed as the oral axis. Also, infants tongue is large as compared to their oropharyngeal cavity. The evidence is susceptibility of airway obstruction soft tissue from the tongue is always possible. Also, be fully aware oropharyngeal space/tongue ratio in the clinical outline of edema of the airway, such as, dental work that has been done recently, surgery or tongue-lip adhesion (Burke et al., 2000). Young children and infants mostly breathe through their noses. The evidence is that those presenting with of respiratory distress and have an upper airway tract infection may have a futile ventilator pattern. It is often upper airway congestion. Importantly, the Intervention is by simple nasal suction so as to reduce the distress. The upper and lower respiratory tracts have a relatively small internal diameter, therefore, predisposing the infant or child to higher airway resistance. An indication is that severe or moderate airway distress can be caused slight inflammation or even mild airway obstruction; due to increasing pressure in the system. Importantly, the treatment is corticosteroids and cool aerosols, inhaled epinephrine for alleviating the inflammation and tracheal edema. Further, inhaled antibiotics can be included in the management in case of an infection so as to alleviate it (Eppich et al., 2006). The cricoid cartilage is perhaps the best known anatomical difference in pediatric patients. Subglottic is the narrowest portion of the pediatric respiratory tract. Additionally, with the cricoid ring being the narrowest point, it is a rational to avoid pressure on it. A clear indication of this there is poor tolerance of any subglottic partial respiratory tract obstruction in children as compared to adults. Clinical examples of this are foreign body aspiration, post-extubation subglottic edema, and mass lesions in the trachea. Moreover, the epiglottis of an infant is floppier and articulates with the larynx at a more acute angle. As demonstrated by the difficulty of displacing an epiglottis with a laryngoscope. It is why a Wisconsin or Miller laryngoscope blade is the tool of choice for intubation, as the whole epiglottis is raised out of the field to be viewed. Although, viewing the inside of the glottis is difficult while performing laryngoscopy (McNiece & Dierdorf, 2004 ). More to the differences, the vocal cords in pediatric and neonatal are more inclined compared to adult patients whose are flat. This can be exhibited or seen where there is the difficulty in passing through the glottic opening by endotracheal tubes as the glottis may ‘hung up' on the vocal cords. Intervention for this is a slight rotation, or a slight twist of the endotracheal tubes may ease passage into the trachea. The pediatric trachea compared to adults is that is more mobile and has a posterior gradient into the thorax, and this may be due to immature cartilage. On the other hand, the adult's trachea is more rigid, and its descent is vertical (Eckel et al., 2000). In conclusion, knowledge of differences in the pediatric airway anatomy will make a practitioner more prepared and provide the proper care for patients, and predict airway emergencies. By understanding the anatomy, the practitioner will be able to improve the respiratory function of the pediatric patients by mediating in simple ways. In clinical practice, one will have the ability to recognize respiratory diseases. Finally, the basic knowledge of pediatric airway will improve the safety of patient's population. References Brambrink, A. M., Meyer, R. R., & Kretz, F. J. (2002). [Management of pediatric airway--anatomy, physiology and new developments in clinical practice]. Anaesthesiologie und Reanimation, 28(6), 144-151. Burke, A. J., Vining, D. J., McGuirt, W. F., Postma, G., & Browne, J. D. (2000). Evaluation of airway obstruction using virtual endoscopy. The Laryngoscope, 110(1), 23-29. Carron, J. D., Derkay, C. S., Strope, G. L., Nosonchuk, J. E., & Darrow, D. H. (2000). Pediatric tracheotomies: changing indications and outcomes. The Laryngoscope, 110(7), 1099-1104. Eckel, H. E., Sprinzl, G. M., Sittel, C., Koebke, J., Damm, M., & Stennert, E. (2000). [Anatomy of the glottis and subglottis in the pediatric larynx]. HNO, 48(7), 501-507. Eppich, W. J., Adler, M. D., & McGaghie, W. C. (2006). Emergency and critical care pediatrics: use of medical simulation for training in acute pediatric emergencies. Current opinion in pediatrics, 18(3), 266-271. Goldmann, K., Roettger, C., & Wulf, H. (2006). The size 1½ Proseal™ laryngeal mask airway in infants: a randomized, crossover investigation with the Classic™ laryngeal mask airway. Anesthesia & Analgesia, 102(2), 405-410. Isono, S. (2006). Developmental changes of pharyngeal airway patency: implications for pediatric anesthesia. Pediatric Anesthesia, 16(2), 109-122. Sagarin, M. J., Chiang, V. I. N. C. E. N. T., Sakles, J. C., Barton, E. D., Wolfe, R. E., Vissers, R. J., & Walls, R. M. (2002). Rapid sequence intubation for pediatric emergency airway management. Pediatric emergency care, 18(6), 417-423. Sternberg, B. S., Erb, T. O., Reber, A., & Frei, F. J. (2005). Opening the upper airway–airway maneuvers in pediatric anesthesia. Pediatric Anesthesia, 15(3), 181-189. McNiece, W. L., & Dierdorf, S. F. (2004, August). The pediatric airway. In Seminars in pediatric surgery (Vol. 13, No. 3, pp. 152-165). WB Saunders. Read More