Portal de Periódicos da CAPES

The infant airway

1994; Springer Science+Business Media; Volume: 41; Issue: 3 Linguagem: Inglês

10.1007/bf03009827

1496-8975

R. E. Creighton,

Congenital Diaphragmatic Hernia Studies

This edition of the Canadian Journal of Anaesthesia conrains an interesting case report t of the anaesthetic management of a neonate with a prenatally diagnosed upper airway obstruction due to a cervical cystic hygroma.Although the obstetrical management may raise questions and deserves separate comment, I will restrict this editorial to the paediatric airway.All presentations, articles and chapters on the paediatric airway start with a litany of the differences between the infant airway and that of the older child and adults.2-4 These include a large head and short neck, the narrow nares, the large tongue, the high glottis, the slanting vocal cords, and the narrow epiglottis which is angled away from the axis of the trachea.At first glance this seems a formidable list of potential difficulties.In practice, there is less than meets the eye in the normal newborn.The difficulty in intubation lies entirely with the size of the mandible.If it is smaller than normal as one finds with Pierre Robin, Treacher Collins and other micrognathic syndromes, intubation may well be difficult, although as the child grows older intubation problems associated with micrognathia diminish.In contrast to the micrognathic syndromes, abnormalities involving the cervical spine, e.g., Klippel-Feil syndrome and connective tissue mucopolysaccharides (Hurler, Scheie, Hunter and Morquio syndromes), do not present severe difficulties in intubation until the second half of the first decade.If the mandible is normal size, intubation in other carniofacial defects, e.g., cleft lip and palate, Crouzon and Apert syndromes, will not present a problem as long as an induction with intravenous agents and muscle relaxants is chosen and not an inhalational one.