and conventional measures have failed, reposition the child to the lat-
eral or prone position. This may alleviate obstruction of the lower tra-
chea or great vessels surrounding the heart.
• Cricothyrotomy. Once you've placed a 14- or 16-gauge angiocatheter
into the cricothyroid membrane, there are several ways to provide
oxygenation. Every anesthesiologist should have a plan for oxygena-
tion through a cricothyrotomy for every case, every day.
• Tracheotomy. If a qualified surgeon is present, this option may be
better than cricothyrotomy. However, it's extremely difficult in small
children and should be considered a last resort. OSM
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J U N E 2 0 1 5 | O U T P A T I E N TS U R G E R Y. N E T
Dr. Litman (litmanr@email.chop.edu) is a professor of anesthesiology and pediatrics at The Children's
Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania. He is
the author of "Basics of Pediatric Anesthesia" (basicsofpediatricanesthesia.com).
