Pediatric airway management: current practices and future directions

Abstract

Management of a pediatric airway can be a challenge, especially for the non-pediatric anesthesiologists. Structured algorithms for an unexpected difficult pediatric airway have been missing so far. A recent step wise algorithm, based on the Difficult Airway society (DAS) adult protocol, is a step in the right direction. There have been some exciting advances in development of pediatric extra-glottic devices for maintaining ventilation, and introduction of pediatric versions of new 'non line of sight' laryngoscopes and optical stylets. The exact role of these devices in routine and emergent situations is still evolving. Recent advances in simulation technology has become a valuable tool in imparting psychomotor and procedural skills to trainees and allied healthcare workers. Moving toward the goal of eliminating serious adverse events during the management of routine and difficult pediatric airway, authors propose that institutions develop a dedicated Difficult Airway Service comprising of a team of experts in advanced airway management.

Managing the challenging pediatric airway: Continuing Professional Development

“…2 Dans la plupart des centres, l'incidence la plus élevée est observée chez les nourrissons (moins d'un an) 3 et les patients atteints d'anomalies cardiaques congénitales. 4 Dans une étude unicentrique récente, l'incidence de laryngoscopie difficile était de 0,68 %, les nourrissons de moins d'un an et les adolescents présentant des anomalies cranio-faciales représentant la majorité des cas.…”

“…2 In most centres, the incidence is highest in the infant age group (less than one year of age) 3 and in patients with congenital cardiac anomalies. 4 In a recent single-centre study, the incidence of difficult laryngoscopy was found to be 0.68%, with infants under one year of age and teenagers with craniofacial anomalies representing the majority of cases.…”

“…7 Nevertheless, the majority of children in that age group will not cooperate in this manner, and as such, most practitioners consider the Mallampati classification to be of little use in children. 8 A more useful assessment tool simply involves observing the child in profile and looking for a recessed or smaller than normal mandible 2 (Fig. 2).…”

Ideal Airway Management: New Evidence and Strategies Are Still Needed

“…For example, management of a pediatric airway can be a challenge, especially for anesthesia providers with limited pediatric experience, who may find the normal airways of younger children difficult to manage. So far, there is no structured algorithms for an unexpected difficult pediatric airway (8) and Airtraq) versus direct laryngoscope demonstrates that videolaryngoscopes are associated with improved laryngeal views in children either with normal airways or with potentially difficult airways. With videolaryngoscopes, however, the intubation time is prolonged and the incidence of failed intubation is increased significantly (11).…”

A randomised comparison of free-handed vs air-Q™ assisted fibreoptic-guided tracheal intubation in children < 2 years of age

“…In addition, these devices may be useful when difficulties with mask ventilation and/or tracheal intubation are encountered [5,6], supporting their inclusion as rescue devices in difficult airway algorithms [7][8][9]. In the paediatric population, children under the age of one year have been reported to have the highest incidence of difficult airway [10,11].…”