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4 yo male otherwise healthy for removal of wires to mandible. His mouth is wired shut. Its gonna take about 30 minutes to remove the wires. How you gonna do the case?
If kid still too squirmy then FOI with 5.0ETT on peds fiberoptic. Deep mask induction. Keep spont vent. Stick tube in.
Fiber optic nasal intubation in a 4 yr old?
can it be done? What is the diameter of a pedi scope?
Nasal fiberoptic if general needed.
If surgeon doesn't need it then whatever. Titrate to comfort but cooperativity...sheeaut. Put some nitrous in his nasal canula if you want. can you tell I'm post call and friggen exhausted.
Nothing beats having to converting your 1.3cc .75bup spinal with 25ucg fent and 200duramorph to general on a 5'3 200lber for c-section. All at 5am after no sleep.
THis is what I was looking for. Are any of you really going to do a FOB on a 4 yo? What is the smallest tube that the pedi scope will fit into? Do you really need to intubate this kid? He had the jaw wired with a 4.5 ETT in place so we know that will fit but can you get a pedi scope through a 4.5 or a 5.0?
My partner did Sevo Mask.
Can you get a 5.0 through a 4 y/o nostril?
My partner did Sevo Mask.
I think as long as you have some sort of backup plan in place for whatever type of emergency (cant vent, laryngospasm, etc) you should be ok. I would also do what FahQ suggested, mask then tube once wires are off. If Im not sure about the surgeon (i.e. if its plastics) or if the airway looks hard I might just nasal FBO and save myself any potential trouble. Of course I havent had to nasal FBO too many kids yet so Im not sure what size tube will fit in what size nostril.
Can you get a 5.0 through a 4 y/o nostril?
I do a fair amount of pedi dentals. I start with the same size ETT as I would try orally, and with lube and vasoconstrictor it usually passes. The issues are length of ETT and leak. Smaller ones are shorter and sometimes don't reach as far as you would like. And there is often a large leak with smaller ETTs, though if you keep spontaneous ventilation it's not such a big issue.
It also depends on the size of the kid...If they're smaller than usual for their age, might have to go down a size.
Don't force it, it's a pain to have nasal bleeding. If it won't pass, go down a half size.