Examples of sizing for paediatric airway equipment are given in Table 28.1. All these sizes are estimations and should not be seen as absolute. We have calculated the weights according to the new APLS formulae and then given examples of tube sizes and depth of insertion so you can look up a starting point easily. Many paediatric drug dosing apps will have this information.
Paediatric airway equipment
| Age | Approx weight (kg) | Guedel airway size (colour)* | LMA | ETT Size/depth (oral) |
|---|---|---|---|---|
| 28/40 | 1 | 000 (pink/clear) | Not used | 2.5/7 cm |
| 33/40 | 2 | 000 (pink) | Not used | 3.0/8 cm |
| 38/40 (term) | 3–4 | 00 (blue) | 1 up to 5 kg** | 3.5/9 cm |
| 3 months | 5.5 | 00 (blue) | 1.5** | 4.0/10 cm |
| Use a straight laryngoscope blade (size 0 up to 6 kg) and a curved blade for > 6 kg | ||||
| 6 months | 7 | 00 (blue) | 1.5** | 4.5/11 cm |
| 1 year | 10 | 0 (black) | 1.5 (up to 10 kg)** | 5.0/12 cm |
| 2 years | 12 | 0 (black) | 2 | 5.5/13 cm |
| 5 years | 18 | 1 (white) | 2 (up to 20 kg) | 6.0/14.5 cm |
| 8 years | 31 | 1 (white) | 2.5 (up to 30 kg) or 3 | 6.5/16 cm |
| 12 years | 43 | 2 (green) | 3 | 7.0/18 cm |
| 16 years | 55 | 2 (green) | 3 (up to 50 kg) or 4 | 7.5/20 cm |
* Guedel colours can change according to the manufacturer, more often seen with adult sizes. Obviously, you should always size it to the patient but we thought it may be useful to include an idea of which one to start with.
** In practice in babies and small infants LMAs often do not sit well and many anaesthetists prefer to intubate (or use a facemask and a regional technique if appropriate).
Breathing
An Ayre’s T-piece (with Jackson Rees modification) can be used up to 20 kg.
Fresh gas flow 2–3 × minute volume for spontaneous ventilation.
Fresh gas flow 1000 ml + 200 ml × weight for controlled ventilation.
A Bain circuit can be used from 20 kg.
A Humphrey ADE system can be used from 10 kg.
A paediatric circle system can be used from 5 kg.
An adult ventilator can be used above 20 kg.
A Newton valve will convert the Nuffield Penlon 200 from a time-cycled flow generator to a pressure generator and is suitable for children up to 20 kg.
Example ventilation parameters are given in Table 28.2.
Paediatric ventilation parameters
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