Tubes and Blades - Kid sized!

By Valeria Chew

Keep in mind with the pediatric airway:

- Epiglottis is floppier

- Head bigger

- Tongue larger

- Cords are more anterior

- Cricoid is narrower

- Low GE tone, small lungs!

Endotracheal tube size

Uncuffed: 4 + (age in years/4)

Cuffed: 3.5 + (age in years/4)

- traditionally, uncuffed tubes used for infants to prevent ischemic injury to trachea, however recent evidence shows you can use cuffed tubes for full term infants and older

Picking a blade size

Generally, straight blades in younger children - better for their anatomy - able to lift up floppy epiglottis 

Can start using curved blades in older children (around age 4).

Premature: 0

Infants: 1

Age 2-10: 2

Age 10-17: 3

Or measure!

Incisor to angle of mandible = length of blade from joint to end

References

Litman R, Fiadjoe J, Stricker P, et al. The pediatric airway. In: Cote C, Lerman J, Anderson B (Eds). A Practice of Anesthesia for Infants and Children, 5th ed. Saunders-Elsevier, Philadelphia 2013. p 237.

Mellick LB, Edholm T, Corbett SW: Pediatric laryngoscope blade size selection using facial landmarks. Pediatr Emerg Care Apr;22(4):226-229, 2006. Copyright Wolters Kluwer Health

Passi Y, Sathyamoorthy M, Lerman J, Heard C, Marino M: Comparison of the laryngoscopy views with the size 1 Miller and Macintosh laryngoscope blades lifting the epiglottis or the base of the tongue in infants and children <2 yr of age. Br J Anaesth 113: 869, 2014.