Emerging trends, techniques, and equipment for airway management in pediatric patients

Abstract

Pediatric patients present unique anatomic and physiologic considerations in airway management, which impose significant physiologic limits on safe apnea time before the onset of hypoxemia and subsequent bradycardia. These issues are even more pronounced for the pediatric difficult airway. In the last decade, the development of pediatric sized supraglottic airways specifically designed for intubation, as well as advances in imaging technology such that current pediatric airway equipment now finally rival those for the adult population, has significantly expanded the pediatric anesthesiologist's tool kit for pediatric airway management. Equally important, techniques are increasingly implemented that maintain oxygen delivery to the lungs, safely extending the time available for pediatric airway management. This review will focus on emerging trends and techniques using existing tools to safely handle the pediatric airway including videolaryngoscopy, combination techniques for intubation, techniques for maintaining oxygenation during intubation, airway management in patients at risk for aspiration, and considerations in cannot intubate cannot oxygenate scenarios.

Comparison of Glidescope Core, C-MAC Miller and conventional Miller laryngoscope for difficult airway management by anesthetists with limited and extensive experience in a simulated Pierre Robin sequence: A randomized crossover manikin study

“…In the last decade, video laryngoscopy has become an important and commonly used tool for the management of difficult airway in pediatric patients, including infants and neonates [16]. In addition, video laryngoscopy has also been shown to be an effective tool in syndromic children with potential difficult airways [10,11,17,18].…”

“…Regarding the primary endpoint ("time to intubate") and the "time to ventilate", no significant differences were observed between the conventional Miller laryngoscope, the C-MAC 1 Miller and the Glidescope 1 Core™. However, the Glidescope 1 Core™ enabled a significantly shorter "time to vocal cords" (p < 0.001, 7 [4][5][6][7][8][9][10][11] vs. 12 [7][8][9][10][11][12][13][14][15][16][17][18], Glidescope 1 Core™ vs. Miller laryngoscope; p < 0.01, 7 [4][5][6][7][8][9][10][11] vs. 10 [7-15], Glidescope 1 Core™ vs. C-MAC 1 Miller) and significantly improved the Cormack and Lehane grade (p < 0.001, 1 Core™ vs. C-MAC 1 Miller). Post-hoc comparison revealed no significant differences for the handling and the difficulty of tracheal intubation.…”

A prospective randomised simulation trial comparing our novel AIR-BOX to standard airway equipment storage modalities

“…9 20–23 Other authors describe swift techniques or innovative tools to serve as back-up for when conventional methods fail. 10 11 24 This has led to the creation of complex algorithms and increasing compilations of innovative equipment. 25 One author described a difficult airway cart with over 220 items.…”

Effects of tip‐manipulated stylet angle on intubation using the GlideScope® videolaryngoscope in children: A prospective randomized controlled trial

“…The airway management in pediatric patients can be challenging because of their unique anatomic and physiological characteristics 4 . The GlideScope can be used for difficult airway management in children 3,5 .…”

“…The GlideScope can be used for difficult airway management in children 3,5 . However, although GlideScope could improve the visualization of glottis, the reported success rate was relatively low, approximately 50%‐60%, 4 along with a prolonged intubation time when compared to direct laryngoscopy and other videolaryngoscopes 6‐8 …”