Recent Advances in Paediatric Airway Management

Abstract

Paediatric airway management is continuously evolving with the innovation of new devices and techniques. The paediatric airway presents notable anatomical and physiological challenges. The introduction of a wide array of videolaryngoscopes and flexible intubating video endoscopes in paediatric sizes has made airway management safer. In addition, second-generation supraglottic airways are increasingly utilised both independently and as a component of hybrid strategies. The introduction of various paediatric airway adjuncts such as Frova introducer, optical stylets and airway exchange catheters has been a valuable addition. Microcuff tubes have proven to be safe for use even in neonates and infants and reduce the number of endotracheal tube exchanges. Apnoeic oxygenation techniques using transnasal humidified rapid insufflation ventilatory exchange help in preventing desaturation during intubation. Point-of-care ultrasound has a multitude of applications in paediatric airway management and is useful technique for the identification of the cricothyroid membrane and assessment of gastric residual volume. Airway assessment and simulation in combination with three-dimensional printing can serve as useful adjuncts in difficult and complicated airways and help in training and skill development and retention. Artificial intelligence and machine learning are in the nascent stages but are continuously evolving and may revolutionise airway assessment in the near future. This narrative review describes the recent advances in airway devices and techniques that have revolutionised paediatric airway management over the past decade.