PedsCrit The Physiologic Difficult Airway with Dr. Proshad Efune
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Oct 2, 2023 Dr. Proshad Efune, a dual-trained intensivist in pediatric ICU and pediatric anesthesiology, discusses the physiologic difficult airway. Topics include high-risk scenarios for cardiovascular collapse during intubation and approaches to minimize risk. They also explore challenges in intubating young children with bronchiolitis, rapid sequence induction in pediatric patients, and the challenges of mask ventilation and ECMO readiness.
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Pre-intubation Optimization for Bronchiolitis
- Pre-oxygenate infants with 100% FiO2 for several minutes before intubation.
- Pre-medicate with albuterol and atropine to minimize bronchospasm and bradycardia.
Induction Agents for Bronchiolitis
- Use propofol for induction in bronchiolitis patients without cardiovascular concerns, aiming for a deep plane of anesthesia (3-4 mg/kg).
- Redose propofol if first intubation attempt fails, as paralysis can mask inadequate anesthesia depth.
Paralyzing and Mask Ventilation in Bronchiolitis
- Paralyze all infants with rocuronium for intubation, considering a lower dose (0.6 mg/kg) if high airway resistance is a concern.
- Avoid mask ventilation in patients with lung disease to minimize gastric distension and worsening hypoxemia.