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Airway-related problems are the most common critical incidents in paediatric anaesthesia and are four times more common in infants than in older children. This chapter discusses anatomical and physiological differences in the paediatric airway. Straight laryngoscope blades are useful in infants up to about the age of 3 to 6 months. In contrast to the tracheal tube (TT), paediatric laryngeal mask airways (LMAs) are sized according to patient weight. There are a number of syndromes and pathologies that are known to be associated with difficult airway management. There are a number of causes, both congenital and acquired, of airway obstruction in the child. The general principles of airway management are the same regardless of underlying cause, however, there are two scenarios that deserve special attention: inhalation of a foreign body, and acute epiglottitis. Rapid sequence induction is not a standard in paediatric practice.
This chapter concentrates on characteristics of the cuffed tube. With a cuffed tube, it is important that the insertion depth is sufficient to avoid inflating the cuff within the larynx itself. Cuffed tubes are generally used in adult practice to seal the airway to protect it from soiling from above and to prevent gas leaks. Three factors contribute to the extent of cuff induced tracheal damage: cuff characteristics, cuff pressure regulation, and cuff inflation technique and medium. Tracheal tubes are attached to the breathing system via tapered male to female 15 mm International Organization for Standardization (ISO) connectors. Tracheostomy tubes with a 15 mm ISO connector can be connected directly to a breathing circuit. Tube characteristics may influence the risk of ventilator-associated pneumonia (VAP). The chapter also reviews special tubes such as laser tubes, microlaryngoscopy tubes, and tubes for paediatric practice.
Devices used for support of patients requiring air rescue or conveyance are subjected to severe environments that may affect their ability to function when needed or may affect other systems within the transporting vehicle.
Methods:
The ability of four portable ventilators, a suction device, and plastic and rubber tracheal tubes to withstand changes in temperature, vibration, sudden deceleration, and electromagnetic fields was studied in the laboratory setting. In addition, the effects of the operation of these devices on the flight instrumentation was investigated.
Results:
All of the ventilators tested delivered stable minute volumes at temperatures above zero, but in sub-zero temperatures problems were encountered with the driving gas. Vibrations produced alterations in the performance of two of the ventilators, and resonant frequencies were detected that are identical to those produced by the rotors of the helicopter used.
Suctioning became difficult at temperatures below −5° C as the mucus froze in the collecting tubing. The motor produced electromagnetic fields that interfered with the aircraft instrumentation, and resonant frequencies had a deleterious effect on the circuit boards. Plastic tubes were adversely affected by cold, and these chilled tubes were excessively sensitive to vibration and shocks.
Conclusion:
The devices used in various aircraft influence certain vital maneuver systems of the craft. Studies on portable ventilators, a suction device, and tracheal tubes showed that, under specific conditions, the equipment was safe to patients and was not hazardous to the aviation safety. However, under certain conditions commonly encountered during air rescue operations, the equipment became dys-functional or presented safety hazards to the aircraft, and, hence, the crew. The Swedish Air Force has adopted three different criteria constellations: 1) operative; 2) storing; and 3) transport environment.
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