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PedsCrit

The Physiologic Difficult Airway with Dr. Proshad Efune

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.
43:01

Episode guests

Podcast summary created with Snipd AI

Quick takeaways

  • Extensive preoxygenation and premedication using albuterol are recommended to optimize intubation in infants with bronchiolitis.
  • Fluid loading and increased infusion rate of vasoactive agents are crucial to prevent cardiovascular collapse in patients with septic shock during intubation.

Deep dives

Physiologic Difficult Airway

Intubating infants with bronchiolitis presents several challenges, including the risk of bronchospasm, hypoxemia, and upper airway obstruction. To optimize intubation in these cases, extensive preoxygenation is recommended, along with premedication using albuterol to reduce airway reactivity. Propofol is the preferred induction agent due to its bronchodilating properties. Paralysis is usually necessary, and rocurophonium is commonly used. Attention should be given to avoid mask ventilating these infants, as it may exacerbate airway resistance. If bronchospasm occurs after intubation, administration of albuterol via the endotracheal tube may help, but if ventilation is ineffective, more propofol can be given.

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