Pediatric Airway Management in Times of COVID-19—a Review of the Evidence and Controversies

Abstract

Purpose of Review This review summarizes and provides a comprehensive narrative synthesis of the current evidence on pediatric airway management during the COVID-19 pandemic. Recent Findings The safe care of children undergoing airway management is a primary concern for pediatric anesthesiologists. The COVID-19 pandemic has brought challenges related to airway management and the use of personal protective equipment, aerosol barriers, and the need for simulation and intubation teams. The risk of COVID-19 transmission to the health care worker may be lower in children due to the smaller volume of aerosol dispersal. The implementation of vaccinations may further reduce the risk to health care workers. Evidence demonstrating the impact of COVID-19 on airway outcomes in children is necessary to inform their care. Summary This review shows that pediatric airway management can be a safe procedure for both the patient and provider in the right setting. The use of appropriate personal protective equipment, particularly focusing on protection from aerosolized particles, is paramount to reduce infection risk. However, there are opportunities for future research.

Surgical outcomes inchildren with perioperative SARS-CoV-2 diagnosis

“…A case report described spinal anesthesia as a safe alternative to general tracheal anesthesia in certain contexts of pediatric surgery to avoid the risks of infection to staff and pulmonary injury to patients 18 . However, Matava determined that endotracheal intubation may be performed safely on infected patients with proper precautions 19 .…”

Timing of surgery and elective perioperative management of patients with previous SARS-CoV-2 infection: a SIAARTI expert consensus statement

“…It should be considered that, in general, even in the case of locoregional anesthesia, the child requires sedation. In literature, it is possible to find suggestions about the routine application of pre-anesthesia in order to avoid crying and coughing with the potential for greater aerosol diffusion in the hospital environment [ 68 , 69 ].…”

COVID‐19 implications for pediatric anesthesia: Lessons learnt and how to prepare for the next pandemic

“…For instance, some of the recent recommendations advocate for the routine use of premedication in order to minimize the risk of children crying and thus coughing and potentially spreading infected micro-particles in the room. 1 Other approaches refer to the more common use intravenous induction for the same reason, use of video-laryngoscopy to minimize contact between the child and the anesthesiologists, etc. The majority of these suggestions are merely expert opinions and rely on poor level of evidence.…”

“…We are obliged to assess the true value of our strategies, approaches, and treatment modalities during this pandemic in a solid scientific manner, and we should not compromise our standards and scientific rigor. 1,2 Certainly, COVID-19 pandemic has impacted the testing, safety, clinical management, and economics of pediatric anesthesia practice, but the long-term consequences are difficult to predict.…”

“…However, there is no magic bullet and the concept of one size fits all does not apply to pediatric anesthesia, and changes in practice can represent an advancement when judiciously applied. We are obliged to assess the true value of our strategies, approaches, and treatment modalities during this pandemic in a solid scientific manner, and we should not compromise our standards and scientific rigor 1,2 . Certainly, COVID‐19 pandemic has impacted the testing, safety, clinical management, and economics of pediatric anesthesia practice, but the long‐term consequences are difficult to predict.…”