Securing the airway in a pediatric patient with head trauma or an intracranial mass lesion plays an important role by correcting or preventing hypercarbia and hypoxemia, factors that can cause increases in intracranial pressure. Since endotracheal intubation itself is inherently stimulating to intracranial pressure, as noted above, all possible precautions should be taken to suppress this response. In addition, in the setting of head trauma, RSI should be undertaken with strict head and neck immobilization due to the potential for concomitant cervical spine injuries.
RSI is the preferred method of intubation in pediatric patients with suspected or known intracranial hypertension. In addition to the agents previously discussed, lidocaine at a dose of 1.5 mg/kg intravenously should be given prior to laryngoscopy. 15 This intervention blocks the rise in intracranial pressure that commonly accompanies endotracheal intubation. It is important to remember that in pediatric patients, as in adults, head injuries can also be associated with intraoral and intratracheal injuries. When managing the airway of a head-injured patient, one must always be prepared for invasive airway management.
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