The majority of pediatric airway emergencies occur in children under 1 year old and are primarily caused by upper airway obstruction from infectious diseases like viral croup. The pediatric airway has unique anatomical features like a higher larynx and narrower subglottic airway that make it more prone to obstruction. Initial management focuses on airway stabilization through suction, positioning, oxygen therapy, and supportive care. Further treatment depends on the specific condition but may include nebulization, intubation, tracheostomy, or endoscopic evaluation and intervention. Outcomes are generally good with resolution of acute issues and management of any underlying structural abnormalities.

2. 80%
10%
10%
respiratory
cardiac
shock
 Majority < 1 year old
 Upper airway obstruction:-
infectious disease (90%), viral croup
(80%)
Epiglottitis (5%)
5% - F.B, external trauma &
congenital anomaly

3.  pediatric airway ×mini adult airway
Nasal & oral
cavity
Pharynx &
larynx
Trachea & large
bronchi

4.  large occiput
 Obligate nasal breathers
 Large tongue
 Higher placed larynx
 Anteriorly angulated
vocal cords

5. • Funnel shaped
larynx
• Narrowest part is
cricoid
• 4-5.5mm

6.  Work of breathing for each kg BW is same in infant&
adult
 O2 consumption 6l/kg/min in children and 3ml/kg/min in
adult
 Greater O2 consumption- inc RR
 Tidal volume is relatively fixed ( 6-7ml/kg/min)
 MAV is more dependent on RR then tidal volume
(130ml/kg/min)
 MAV/ FRC is double , so during hypoxia ,apnea &
anesthesia , desaturation occurs rapidly
 Poiseuille,s law

8.  Age :- laryngomalacia( birth)
ALTB ( <3yrs)
F.B ( <15ys)
Epiglottitis ( 2-6 yrs), retropharyngeal abscess ( 1-4 yr)
 Presenting c/o : dyspnoea
 Noisy breathing – onset
Progression
Variability
Association with sleep, crying,
feeding
Other aggravating & relieving
factors

9.  Associated or preceding URI, fever.
 h/o chocking episode, Fb intake
 COUGH:- nature
Onset
Progression
Aggravating & reliving factors
 VOICE change
 Difficult feeding
 Cyanosis
 Neck swelling
 h/o asthma & repeated pneumonia
 h/o intubation, birth trauma

10.  General appearance of child with careful attention:
 Level of consciousness:-
 Decrease interaction
 Irritability
 Restless
 Anxious
 Diaphoresis
Air hunger and hypoxemia

12. Increase work of breathing:
Respiratory rate
Nasal flaring
Chest retractions
Accessory muscle use
Head bobbing
Grunting
Tripod position

13. Nose – mucus , swelling
Tongue, craniofacial anomaly
Vomitus, bleeding, Secretions in mouth
Abnormal airway sounds:- stridor
Stertor
Wheeze
Grunting
Inspiratory or expiratory
Circulation:- pallor, cyanosis , skin temperature &
auscultatton.

15. Pierre Robin S. Treacher Collins S.
Down S.
Cruzon syndrome

17.  suctioning, positioning & supportive care are the
key elements.
 Stabilization of airway is primary importance during
initial resuscitation.
 Goal of airway
management :- relieve anatomical obstruction.
prevent aspiration
Promote adequate gas exchange

18. ACUTE AIRWAY MANAGEMENT:-
 Suction nose & nasopharynx
 Positioning:- reposition/ allow child to assume position
of comfort
 Head tilt, chin lift/ jaw thrust position

20.  Oxygen therapy:- reduces the ventilatory requirement of
oxygen.
cardiac & respiratory arrest.
Hypoxemia
Metabolic acidosis
Respiratory distress
 Blood pressure, O2 saturation .
 Nebulization with adrenaline (1:3) or bronchodilators.
 Humidification/ steroid
 Heliox mixture:- 79% He and 21% O2
 Oropharyngeal/ bag and mask ventilatio
 Emergency airway access:-Intubation/ tracheostomy

21. Oropharyngeal airway

23. Endotracheal tube
Tracheostomy tube

24.  Imp laboratory test is ABG
 PaO2- 80-100 mm hg
 PaCo2- 40±5 mm hg
 pH- 7.40± 0.05
 O2 sat- >95%
 CBC, SE
RADIOLOGICAL - not done routinely
 Xray STN lateral view
 Xray chest AP view
 Xray chest lateral oblique view
 CT scan- choanal atresia

27. Acute airway conditions:-
 Epiglottitis:- stabilize the child
Avoid taking blood sample/ chest x ray
Anesthetic induction-sitting position
Endotracheal intubation
Tracheostomy.
 Laryngotracheobronchitis:-
O2 therapy
Humidification
nebulization with adrenaline
Steroid/ antibiotics
intubation

28. RETOPHARYNGEAL ABSCESS:-
 Maintaining airway
 Antibiotics
 Incision & drainage
Foreign Body airway
 Bronchoscopy and removal

29. Endoscopic evaluation:-
Nasopharyngolaryngoscopy
Laryngotracheoscopy
Microlaryngoscopy- gold standard
bronchoscopy

30.  Access nares/ choana, adenoid , lingual tonsil
 Dynamic study
 access laryngeal structures
 Can be used under LA & bedside
 Thick tongue base, overhanging epiglottis & laryngeal
scars
 High cost & less manipulation.
 Less compliance

31.  Doesn’t require GA
 Mainly diagnostic purpose
 Limited intervention
 Can be used for intubation
 Limited airway control

32.  Requires GA
 Better airway control
 Easier intervention
 Laryngoscope
 Ventilating bronchoscope
 Hopkins rod telescope
 Operating microscope

33. MICROLARYNGOSCOPY

34.  Spontaneous resolution 18months- 2years
 Surgical intervention:- late onset >2 yrs
 10% severe laryngomalacia – failure to
thrive,hypoxemia, osa, pulmonary hypertension.
 supraglottoplasty or laser epiglotopexy

35. Glottic web: anterior or posterior
 Endoscopic laser , scissors followed by stent palcement
Vocal cord palsy:-
U/L palsy – observation
Rarely intubation
B/L vocal cord palsy:- tracheostomy
At least for 2 years- spontaneous recovery in
half of the Patients
Vocal cord lateralization

36. .
Congenital Subglottic stenosis: lumen diameter
<4mm in term & <3mm in preterm
 resolves spontaneously with growth
 Tracheostomy with decannulation at 3-4 years
 Laser ablation if thickness <5mm
 Laryngotracheoplasty- severe cases

37. Acquired subglottic stenosis:
 Initially- steroids
 Mild glanular stenosis- serial endoscopic dilatation
with or without steroid injection
 CO2 laser- circumferential soft stenosis
 Open surgical resection – grade III & IV
 Laryngotracheoplasty
 Laaryngotracheal reconstruction
 stenting