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Recognise the paediatric patient in respiratory distress and identify the signs of impending respiratory failure. Describe the modifications that may be needed to achieve safe induction of anaesthesia and tracheal intubation in the paediatric patient in respiratory distress. Describe the emergency management of children in respiratory distress with a tracheostomy.Anaesthetists are part of the paediatric emergency response team in hospitals throughout the UK. These teams respond to all paediatric emergencies within the hospital. Respiratory disease is the most common reason for acute hospital admission in children, so it follows that a large number of paediatric emergencies result from severe respiratory distress or imminent respiratory failure. Often, by the time an emergency call is put out or a referral to the anaesthetist is made, the child has deteriorated significantly and usually requires non-invasive or invasive ventilation and transfer to a paediatric ICU (PICU). There are many causes of paediatric respiratory distress with varying treatments and prognoses. A good working knowledge of these diseases and their management can inform and assist with anaesthetic intervention in this stressful situation.This article summarises the common causes of paediatric respiratory distress and the anaesthetic management thereof. The causes of stridor and respiratory compromise secondary to this have been covered recently in this journal, and will not be discussed here. 1 Bronchoconstriction and wheezingAsthma affects one in 11 children. In 2016 asthma caused 6783 emergency admissions to hospital in patients aged 0e14 yrs. Whilst hospital admissions are common, fatality is fortunately rare with 12 deaths in the same age group in the UK in 2016. 2 The pathogenesis is not fully understood. However, variable airflow obstruction and airway hyper-reactivity are involved. Exacerbations may be infective or non-infective; the majority of infective exacerbations are caused by viral infection. The joint British Thoracic Society and Scottish Intercollegiate Guidelines Network guidelines outline the treatment for children admitted to a hospital as follows: 3 (i) Oxygen (method dependent on severity: low-flow nasal cannulae, Hudson face mask, or high-flow nasal cannulae)(ii) Nebulised b 2 -agonists with the addition of an inhaled anticholinergic if response is poor Joanne Challands FRCA is a consultant paediatric anaesthetist at the Royal London Hospital.

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