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Chapter 50. A Neonate with a Difficult Airway and Aspiration Risk

Which of the following risk factors are associated with increased complications during difficult airway management in a child?

A. a body weight less than 10 kg

B. short thyromental distance

C. persistent direct laryngoscopy attempts (>two attempts)

D. all of the above

(D) These three factors were identified from the Pediatric Difficult Intubation (PeDI) registry as independent risk factors with the occurrence of any complication.

Which of the following interventions are least likely to improve extraglottic upper airway obstruction during difficult airway management in a neonate with Pierre Robin?

A. extraglottic device insertion

B. neck extension

C. nasal trumpet insertion

D. prone positioning

(B) Answers A and C are invasive options which will both bypass the posterior third of the tongue to aid in overcoming upper respiratory obstruction. Prone positioning (D) will bring the tongue forward by gravity and may help with upper airway obstruction. Neck extension (B) may help with minor airway obstruction, but will not reliably overcome severe obstruction, especially in the case of a Pierre Robin child.

Which of the following is true regarding awake extraglottic device placement in a neonate with a difficult airway?

A. An awake extraglottic device placement is not well tolerated.

B. An intubating extraglottic device such as an air-Q can be used to facilitate rapid sequence tracheal intubation.

C. Evidence of extraglottic airway obstruction such as sternal retractions is a contraindication to extraglottic device insertion.

D. Toxicity to local anesthetics precludes use of topicalization prior to placement of an extraglottic device.

(C) Previous case reports have described EGD placement in neonates as well tolerated, atraumatic, and can facilitate rapid sequence intubation. Local anesthetic topicalization can be applied prior to placement. However, extreme caution must be exercised to avoid excessive amount of local anesthetic used. Upper airway obstruction can often be overcome by EGD placement.

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