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Difficulty Inserting Cuffed Endotracheal Tubes in a Child: A Case Report.
Keiko Imai1, Taku Doi, Kenji Kayashima
1From the Department of Anesthesia, Japan Community Health Care Organization, Kyushu Hospital, Kitakyushu, Fukuoka, Japan.
A & a Case Reports
|October 18, 2016
Summary
Selecting the correct endotracheal tube (ETT) size is crucial for pediatric patients. Consider both cricoid cartilage width and ETT outer diameter, including deflated cuff dimensions, to avoid insertion difficulties.
Area of Science:
- Pediatric Anesthesiology
- Airway Management
- Medical Device Engineering
Background:
- Proper selection of endotracheal tubes (ETTs) is vital for pediatric airway management.
- Cuffed ETTs are increasingly used but pose challenges in narrow pediatric airways.
Observation:
- Difficulty was encountered inserting 4.5-mm and 5.0-mm inner diameter (ID) cuffed ETTs in a 5-year-old boy.
- Ultrasound revealed the cricoid cartilage's transverse width was 8.0 mm.
- The outer diameter (OD) of the deflated cuffs of the 4.5-mm and 5.0-mm cuffed ETTs measured 8.5 mm and 9.6 mm, respectively.
Findings:
- A 5.5-mm ID uncuffed ETT with an OD of 7.6 mm successfully passed the cricoid cartilage.
- The outer diameter of cuffed ETTs, even when deflated, can exceed the internal width of the pediatric cricoid cartilage.
Implications:
- Cuffed ETT selection in children requires careful consideration of the cricoid cartilage's dimensions.
- ETT outer diameter, including deflated cuff measurements, is a critical factor in preventing difficult intubations.
- This highlights the need for precise ETT sizing guidelines in pediatric patients.
