Proposal for the management of the unexpected difficult pediatric airway

Abstract

SummaryThe incidence of unanticipated difficult or failed airway in otherwise healthy children is rare, and routine airway management in pediatric patients is easy in experienced hands. However, difficulties with airway management in healthy children are not infrequent in nonpediatric anesthetists and are a main reason for pediatric anesthesia-related morbidity and mortality. Clear concepts and strategies are, therefore, required to maintain oxygenation and ventilation in children. Several complicated algorithms for the management of the unanticipated difficult adult and pediatric airway have been proposed, but a simple structured algorithm for the pediatric patient with unanticipated difficult airway is missing. This paper proposes a simple step-wise algorithm for the unexpected difficult pediatric airway based on an adult Difficult Airway Society (DAS) protocol, discusses the role of recently introduced airway devices, and suggests a content of a pediatric airway trolley. It is intended as an easy to memorize and a practical guide for the anesthetist only occasionally involved in pediatric anesthesia care as well as a call to stimulate discussion about the management of the unanticipated difficult pediatric airway.

Usability and performance characteristics of the pediatric air-Q® intubating laryngeal airway

“…is a SGD specifically engineered for use as both a primary airway and a rescue or ''Plan B'' device in the event of a difficult airway. 7,8 Its design allows insertion of a tracheal tube through its lumen, either blindly or mounted on a fibreoptic bronchoscope (FOB), to achieve tracheal intubation.…”

Supraglottic airways in difficult airway management: successes, failures, use and misuse

“…Comparable uses can also be found in many other national recommendations such as those from Germany or Italy [12,13]. In addition, Weiss and Engelhard recently published a proposal for management of the difficult paediatric airway [14]. In the situation of failed facemask ventilation and failed tracheal intubation, they recommended the use of the LMA or ILMA first for ventilation and also as a conduit for tracheal intubation.…”

Intraoral Finger Stabilization of Proseal LMA for Adequate Rescue in cannot Ventilate, cannot Intubate and cannot be Tracheostomized Situation

“…To provide adequate oxygenation needle cricothyrotomy is often a recommended procedure however it is not recommended in children under age 5 due to more complications. [8] Moreover, landmarks were obscured too in the present case.…”