Infants desaturate within seconds of apnoea because of high oxygen consumption and small functional residual capacity. First-pass success depends as much on preparation as on the laryngoscope.
Preoxygenate well, use apnoeic oxygenation through nasal cannulae where available, and position with a neutral head and a shoulder roll in neonates. Agree a time limit before starting — typically about 30 seconds — and a clear threshold for abandoning the attempt and reoxygenating. Have the alternative device and a supraglottic airway ready.
- Preoxygenate and use apnoeic nasal oxygen where possible
- Neutral head position with a shoulder roll in neonates
- Agree the attempt time limit and abort threshold before you start
- Keep a second device and a supraglottic airway open on the trolley
- Let the most experienced operator make the first attempt in high-risk infants
Why it matters
Most hypoxic harm in infant intubation comes from prolonged or repeated attempts.
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