Episode 36: Pediatric respiratory anatomy and physiology with Dr. Schwengel

In this episode, episode 36, I welcome Dr. Deb Schwengel, one of our pediatric anesthesiologists and our residency program director, to the show to discuss the differences in anatomy and physiology in pediatric versus adult patients.

6 Replies to “Episode 36: Pediatric respiratory anatomy and physiology with Dr. Schwengel”

  1. Fantastic talk! I really enjoyed when Dr. Schwengel gave a detailed description of how to properly mask ventilate (or even manually ventilate when an endotracheal tube is in place) pediatric patients who have become hypoxic. I often struggled to improve oxygenation in pediatric patients, especially those with pre-existing lung disease. But when someone finally described to me in detail, just as Dr. Schwengel did, how to properly manually ventilate a pediatric patient, it made a word of difference!

    1. Glad it was helpful Stephen, and thanks for listening. I, too, find it really helpful to hear tips from experts who have been doing it for a long time.

  2. Awesome episode as always! I have one point to add to the discussion of cuff inflation to avoid pressure necrosis in pediatric patients…As was mentioned in this episode, nitrous is often used in peds patients. If there is still a competent valve to the cuff nitrous can diffuse into the cuff over the course of a case and may alter the cuff pressure you are aiming for.

    “Cuffs also differ in their shapes and positions along the endotracheal tube. In addition, because nitrous oxide diffuses into the closed airspace of an endotracheal tube’s cuff when the inflation valve is closed, this valve should be rendered incompetent during long procedures. Otherwise, the intracuff pressure should be monitored and maintained at a level below 25 cm H 2 O (18.4 mm Hg).” [1]

    As Dr. Schwengel pointed out the decision should always consider patient comorbidities.

    -Leif
    Stony Brook University Anesthesia Resident

    1) Davis, P. and F. Cladis, Smith’s anesthesia for infants and children. 9th ed. 2017, Philadelphia, Pa.: Mosby. Chapter 18 section on endotracheal tubes.

  3. Good point. I would be careful with rendering the cuff incompetent as you may end up at higher risk for aspiration. Other options include taking air out occasionally, as you mentioned, and also filling the cuff with saline instead of air.

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