Newborn up to 1 year (0 – 10 Kg)

Facemasks: Intersurgical sizes 0 and 1Laerdal sizes 0 and 1 (re-usable)

Oropharyngeal Airway (sizes 000, 00 and 0)

ETT sizes 2 and 2.5 (uncuffed)ETT sizes 3 and 3.5 (microcuff)Stylet (small)

Laryngoscopes:Robertshaw blades sizes 0 and 1 (Proact single use)Proact single use paediatric handle (with batteries)LMA Unique, sizes 1 and 1.5

Advanced Airway Equipment

Dressing packSingle use No. 15 scalpelTracheal dilators and tracheal hook

Gastric tubes: 6F, 8F, 10F, 12F50ml catheter tip syringe & 20ml standard syringeLidocaine 4%MAD x 1Cook Airway Exchange Catheters: 8F, 11F, 14FGlidescope Sheath (size 1, size 2 and size 3)Infant Airtraq x 1

REFERENCES1. Association of Anaesthetists of Great Britain and Ireland. Paediatric Airway Guidelines 2012, 2012. http://www.apagbi.org.uk/publications/apa-guidelines (accessed

27/01/2013)2. Weiss M, Engelhardt T. Proposal for the management of the unexpected difficult pediatric airway. Pediatric Anesthesia 2010; 20: 454-4643. Fourth National Audit Project of the Royal College of Anaesthetists and Difficult Airway Society. Major complications of airway management in the United Kingdom.

Report and Findings. March 2011. ISBN 978-1-9000936-03-3 Royal College of Anaesthetists. London http://www.rcoa.ac.uk/nap4/ (accessed 24/01/2013)

New Guidance, New Approach: The Airway Rescue Trolley in Paediatric Practice

Willis N, Li L, McGuire B and Rodney GDepartment of Anaesthesia, Ninewells Hospital, Dundee, UK

Discussion

Since their inception in 2004, the Difficult Airway Society’s guidelines have become established practice. In 2012, The Association of Paediatric Anaesthetists and the Difficult Airway Society published guidance [1] for use in children aged one to eight years old. Part of our implementation of these guidelines in our department was to introduce a ‘paediatric airway rescue trolley’ to simplify the approach to the difficult paediatric airway.

Introduction

The safest way to manage the difficult airway, both anticipated and unanticipated, is by using an uncomplicated, step-wise approach of increasing intervention and only using equipment with which we are confident, well-practiced and familiar. We believe our trolleys embody this ideology and their presence will improve patient safety. Equally importantly, their presence will help teach the management of the difficult airway in paediatric practice, help to publicise and implement the new APAGBI/DAS guidelines, and stimulate discussion around paediatric airway management.

Methods

Following our recent introduction of simplified adult airway rescue trolleys and calling on a variety of published resources [1, 2, 3], the decision was made to mirror this ethos in paediatric practice. The aim was to make essential equipment both more visible and accessible when required and to avoid the overuse of specialised airway equipment in an emergency. The priority for equipment choice was familiarity – hence the focus on facemasks, basic airway adjuncts, supraglottic airway devices and appropriate equipment for intubation, including stylets and intubating catheters.

Results

Three trolleys were purchased: One was placed in the paediatric theatre suite, another in the main adult theatre suite (where out-of-hours paediatric surgery takes place), and a third in the out-patient dental area. All are clearly signed and stored in plain view. The trolley has five colour-coded drawers, the first four (from top-down) are assigned an age and weight value as a guide (clearly displayed on the front of the drawer), and the equipment contained therein tailored for that age/weight of child. The fifth (bottom) drawer contains select advanced airway equipment, aiming to cover the ‘can’t intubate, can’t ventilate’ scenario, as well as difficult laryngoscopy and intubation.

Table 1 - The colour coding system used for the PART. Table 2 shows content lists of two of the PART drawers.

(A) The Paediatric Airway Rescue Trolley (PART) with colour-coded drawers according to age and weight. Figures (B) and (C) show the standardised contents of two different drawers. Each drawer stocked with size appropriate and familiar airway equipment.

A B C

Newborn up to 1 year (0 – 10 Kg)

1 to 6 years (10 – 20 Kg)

6 to 12 years (20 – 30 Kg)

12 years and over (> 30 Kg)

Advanced Airway EquipmentTable 1

Table 2