Epiglottitis
Considerations
-
Impending airway obstruction:
-
Difficult bag mask ventilation & intubation
-
Do not upset child or manipulate airway
-
-
Emergency: risk of aspiration, ↓ time to optimize
-
Sepsis & need for early goal-directed therapy
-
Pediatric patient considerations
-
Post-op disposition: PICU & plan for extubation once process resolved
Management
-
Call for ENT ("double set up") & maintain spontaneous ventilation
-
Use smaller endotracheal tubes (1-3mm smaller)
-
OR set up with second anesthetist or anesthesia assiant & difficult airway cart, rigid bronchoscopy & tracheostomy set
-
Skin topicalization for IV start
-
Obtain CBC & blood cultures
-
Fluid bolus 20 ml/kg, repeat prn
-
Aspiration prophylaxis ranitidine 0.5 mg/kg & maxeran 0.1 mg/kg
-
Glycopyrrolate 10 mcg/kg to dry secretions
-
Small styletted ETT (cuffed preferable)
-
Spontaneouly-breathing induction with sevoflurane or propofol/remifentanil if IV, then intubate
-
IV antibiotics, fluids, PICU post-op:
-
Antibiotics: cloxacillin, cetriaxone, ampicillin, clindamycin +/- vancomycin
-
-
Extubation plan: ensure there is a leak & swelling has resolved. Then extubate in the OR & be prepared for re-intubation
-
Don't use steroids empirically but consider if extubation has proven difficult after several days of antibiotic therapy