Anesthesia Considerations 

Croup/Laryngotracheobronchitis

 

 

Considerations

 

• Pediatric patient considerations

• Possible airway difficulty & complications:  

  • Consider double set-up, rigid bronchoscope, spontaneously breathing patient

  • Obstruction, laryngospasm

  • Respiratory fatigue/failure

  • Super infection with bacterial trachietis possible

• Dehydration, need for volume replacement 

• PICU & extubation plan

 

 

Treatment

 

• Nebulized epinephrine 0.5 ml/kg of 1:1000 to max 5 ml q15-20 min

• Dexamethasone 0.6 mg/kg PO or 0.15-0.3 mg/kg IV

• Budesonide 2 mg via neb (2 ml)

• Humidified O2

• Heliox 

• Approach to intubation:

  • Perform in OR with difficult airway cart & ENT +/- rigid bronchoscopy 

  • Use small endotracheal tube, cuffed & stylet