Respiratory arrest, gasping or cardio-respiratory arrest are, of course, formal indications for mechanical ventilation. Concomitant use of a benzodiazepine can suppress the dysphoric effects of ketamine . However ketamine increases laryngeal secretions but does not block pharyngeal and laryngeal reflexes, increasing the risk of laryngospasm and aspiration in the preintubation period. Pancuronium should be avoided for its histamine release effect. Manipulation of the airway in the asthmatic child can worsen the bronchospasm or provoke a laryngospasm.
Oral intubation is preferred in large children and is the method of choice.
After intubation, overenthusiastic bagging can result in hypotension or pneumothorax. To treat this hypotension due to hyperinflation, fluid boluses should be administrated quickly. The endotracheal tube could also be temporary disconnected from the ventilator or the anesthesia bag, allowing airway pressure to decrease.