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At 05:03 PM 13/07/95 -0700, Steven Szabo wrote:
 
>Simon,
>
>Is there an age limit to pediatric naso-tracheal intubation in Australia ?
>If not, what size would you use in a 2 years old toddler?
>
>Steven
 
My paediatric anaesthetic/ICU experience is limited to working in the UK
where nasal intubation (at least where I worked) was considered at any age
(but naturally one was careful about knocking of any adenoidal tissue!). I
have not heard anything different at home in Oz. I have spent some time in
neonates here, where nasal intubation seems to be the route of choice
(following initial oral intubation if necessary).
 
How do things differ in the US?
 
From my little book: 2 y.o toddler: ID 4.5 mm, ED 6.2 (Mallinkrodt), 15 cm
at the nose. (Same ID, oral or nasal.)
 
I generally cary my little book around (see below), cause I don't deal with
sick kids that often, and have a shocking memory! If I'm stuck though, I
just use those good old formula:
 
Internal Diameter (mm) = 4 + age/4 (adult 8-9 mm)
External Diameter (mm) ~ external dia of tip of little finger
Length (cm) at LIP = 12 + age/2 (adult 21-23 cm)
Length (cm) at NOSE = 15 + age/2 (adult 24-26 cm)
 
Trouble is that I periodically keep forgetting the latter two formula ("was
that a 15 or a 16?"), so I then insert and determine the appropriate length
under direct vision. The procedure taught to me was to advance the nasal
tube to the glottis while the oral tube was still in-situ, determine the
appropriate length directly, cut and insert the connector/catheter mount,
pull out the oral tube, advance the nasal and secure.
 
As to "the little book": If you want a really good paeds referrence book,
albeit with an Australian flavour, (very thin and fits in any pocket, with
tables, charts, drug doses, fluid regimes, tube sizes etc), try:
 
Drug Doses
Frank Shann
(Intensive Care Unit,
Royal Childrens Hospital,
Melbourne)
 
ISBN 0 646 16440 6
 
Telephone 61 3 345 6429 or Fax 61 3 345 5789 for pricing (it is really cheap
but really good)
 
And no, I do not have any financial interest in the book!
 
Dr Simon Brown
Registrar
Department of Emergency Medicine
Royal Brisbane Hospital
Queensland, Australia
Email [log in to unmask]