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Chapter 45. Unique Airway Issues in the Pediatric Population

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Regarding succinylcholine (suxamethonium) use in children under 16 years of age:

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A. the FDA defines it as relatively contraindicated

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B. the FDA defines it as contraindicated

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C. the FDA has approved it only in emergency situations

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D. the FDA has warned against its use in various settings

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E. the FDA has never issued any warning regarding its use

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(D) In 1994, the FDA reversed its earlier relative contraindication to use succinylcholine in children under the age of 16 years decision and downgraded their recommendation to a warning.

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Cuffed endotracheal tubes

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A. are associated with increased in airway injury compared to uncuffed tubes in children less than 2 years

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B. have not been associated with increased airway injury in children less than 2 years compared to uncuffed tubes

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C. have to have their cuff pressure measured and maintained at less than 30 cm H2O

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D. are not available for children less than 2 years

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E. should not be used for infants

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(B) There is no question that damage to the airway can occur with both cuffed and uncuffed tubes. However, there is no evidence today to suggest that cuffed tubes are associated with increased airway injury in children of any age, including less than 2 years of age, compared to uncuffed tubes.

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Which of the following is true regarding rapid sequence intubation (RSI) in children?

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A. Rocuronium is the drug of choice.

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B. Cricoid pressure improves laryngoscopic grade upon direct laryngoscopy.

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C. It is safer in adults versus infants.

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D. Cricoid pressure is effective in decreasing gastric insufflation even with ventilation pressures greater than 40 cm H2O.

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E. RSI is contraindicated in neonates.

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(D) When emergency intubation is indicated, RSI is the technique of choice in children, as it is in adults. The sequence of events and drug selection for RSI are no different in children than it is in adults. While the effectiveness of cricoid pressure in preventing gastric aspiration remains controversial, cricoid pressure is effective in decreasing gastric insufflation even with ventilation pressures greater than 40 cm H2O.

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