Anesthesia for intubation in young children

This is an automatically translated article.

The article was professionally consulted by Specialist Doctor II Dinh Van Loc - Department of General Surgery - Vinmec Danang International General Hospital. Dr. Loc has advanced training in Anesthesiology and has more than 23 years of experience in anesthesia.
Children who are indicated for thoracic surgery, ENT surgery, major surgery, high risk, ... will be assigned endotracheal anesthesia. Anesthesia for tracheal intubation in young children should be performed carefully and in accordance with the correct procedure in order to minimize the risk of complications and ensure the success of surgery.

1. Indications/contraindications for anesthesia for intubation in young children

1.1 Designation

Ear - nose - throat and tooth - jaw - face surgery; Thoracic surgery: Heart, lungs; Surgery requiring the use of muscle relaxants such as abdominal surgery, intestinal volvulus, intestinal obstruction, peritonitis; Major surgery, heavy blood loss and shock; Surgery with an unfavorable position such as the baby lying on the stomach, side or sitting; Surgery requires airway control; Surgery in children at risk of reflux; Surgery involves damage to the lungs and many other organs.

1.2 Contraindications

The operator is not technically proficient; No means of artificial respiration; Children with acute respiratory infections.

2. Preparation for endotracheal anesthesia in children

Performer: Anesthesiologist and assistant; Equipment: Anesthesia machine, oxygen, suction machine, catheter, sphygmomanometer, vital indicators monitor, ambu ball, canule mayo, mask, laryngoscope, bronchospasm sprayer, Xylocaine nebulizer, endotracheal tube of appropriate size for the child (the diameter of the tube is equal to the diameter of the child's nostril or the diameter of the tip of the child's little finger); Drugs: Pre-anesthetic drugs with doses calculated according to the child's weight; Seduxen, Midazolam, Atropin in appropriate doses;

Pediatric patients: Hospitalization should be accompanied by a mother; to learn about their physical condition, disease, and planned surgery; ask the child's medical history; find out the child's reactions to the drugs used; learn the history of surgery, anesthesia and anesthetic used; ear - nose - throat - oral examination; do the necessary tests; for children to fast, fast for 6 hours before surgery; can drink water or water mixed with sugar 3 hours before surgery; gastric lavage if necessary; enema before surgery; guide children to practice breathing and coughing; infusion for children; give the child oxygen through a mask; passion money.

3. The process of anesthesia intubation in young children

Step 1: Induction of anesthesia and intubation
Children usually initiate anesthesia with a respiratory anesthetic such as sevorane Intravenous induction, using one of the drugs Ketamine, Thiopental or Propofol with appropriate doses; Apply 100% oxygen squeeze ball mask to pediatric patients; For children using muscle relaxants: Use one of the drugs Suxamethonium, rocuronium, vecuronium or Atracurium with appropriate dosage; Intubation for pediatric patients: is a delicate and very gentle operation, otherwise it will cause trauma and edema of the larynx. Hold the laryngoscope, insert the blade into the child's oral cavity; Then, holding the endotracheal tube, insert the tip of the tube through the opening of the vocal cords into the trachea. Next, remove the laryngoscope, inflate the endotracheal tube if present, attach the respiratory system to the oxygen balloon, and examine the chest and abdomen. Finally, secure the endotracheal tube using adhesive tape.

Step 2: Maintain anesthesia
Ensure the following factors: Anesthesia, analgesia, muscle relaxation, vital functions by adjusting the drugs and anesthetic system accordingly; Maintain anesthesia with inhalational or intravenous anesthetics and analgesics and muscle relaxants. Step 3: Resuscitation, extubation
Only extubate when the child fully meets the following conditions:
Self-breathe is good in both amplitude and frequency; (the effect of morphine is over) Only the minimum SpO2 must reach over 96% when ventilation with oxygen support; Children perform the correct movements as required: Open eyes, open mouth, stick out tongue, shake head, lift head off the table,.( End of muscle relaxant effect: TOF≥ 90%

4. Risk of complications and measures to deal with it

Apnea, asphyxiation: It can be caused by high concentration anesthetic injection, rapid injection or by muscle relaxant but not timely artificial respiration. Treatment measures are close monitoring when injecting anesthesia, respiratory support and timely command respiration; Bronchospasm : Manage by giving the child antispasmodics (Salbutamol nasopharyngeal or endotracheal tube) or artificial respiration with an ambu balloon with oxygen mask or endotracheal intubation. ; Laryngeal spasm: The appropriate intervention is to apply a high-pressure oxygen balloon mask to the child. At the same time, let the child sleep more deeply, use muscle relaxants, give artificial respiration until the muscle relaxant runs out, and the child breathes well on his own. If necessary, intubation and artificial respiration can be performed; Vomiting causes reflux: The way to prevent it is to insert a gastric suction tube in the child before anesthesia. If the child has reflux, it is necessary to aspirate the bronchi with 0.9% saline serum, give the child antibiotics, high-dose corticosteroids, oxygen therapy and mechanical ventilation if necessary;

Cardiovascular collapse: Treat with discontinuation of antihypertensive anesthetics, intravenous fluids, and possibly cardiac inotropes if necessary. If the child has a cardiac arrest, treat the circulatory arrest immediately; Injury to the teeth, mouth, gums, and throat: This complication should be prevented by using a protective crown, performing gentle intubation anesthetic movements. Wrong placement of the endotracheal tube into the esophagus: If the check shows that the wrong tube is placed, it should be removed, masked with 100% oxygen and then repositioned the endotracheal tube in the correct position; Endotracheal intubation deep into one bronchus: This complication causes hypoxia, atelectasis, and hypercapnia. The doctor needs to listen to check, adjust the endotracheal tube to the right position, fix the tube firmly and give artificial respiration to the child. If there is atelectasis, perform bronchoscopy and drainage according to position; Hypoxia, hypercapnia: Caused by tube fall, tube blockage, endotracheal tube folding. The doctor needs to check the child's respiratory system regularly, if the breathing pressure drops, it may be due to a fall or open tube; Inspiratory pressure increases due to tube folding. The treatment depends on the cause of hypoxia and hypercapnia. If the tube is blocked due to sputum, endotracheal suction and if necessary, the endotracheal tube can be replaced; Hypothermia : Due to evaporative anesthesia, a semi-open system is used but the air is not humidified or warmed. Manage by heating the patient, infusing warm serum at 37°C and providing oxygen support. The procedure of anesthesia for tracheal intubation in young children needs to be done clearly and closely, ensuring the right steps to improve the effectiveness of successful therapy, and to minimize the risk of complications.

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