The management of unanticipated difficult airways in children of all age groups in anaesthetic practice - the position paper of an expert panel

Abstract

Children form a specific group of patients, as there are significant differences between children and adults in both anatomy and physiology. Difficult airway may be unanticipated or anticipated. Difficulties encountered during intubation may cause hypoxia, hypoxic brain injury and, in extreme situations, may result in the patient’s death. There are few paediatric difficult-airway guidelines available in the current literature, and some of these have significant limitations. This position paper, intended for unanticipated difficult airway, was elaborated by the panel of specialists representing the Polish Society of Anaesthesiology and Intensive Care as well as the Polish Neonatal Society. It covers both elective intubation and emergency situations in children in all age groups. An integral part of the paper is an algorithm. The paper describes in detail all stages of the algorithm considering some modification in specific age groups, i.e. neonates.

The prevalence of difficult airway and its associated factors in pediatric patients who underwent surgery under general anesthesia: An observational study

“…1 Pediatrics have a large tongue, large head, anterior larynx, smallmouth, narrow airway, and low functional residual capacity, and they are hard to intubate. [3][4][5][6][7][8] MV, direct laryngoscopy, and endotracheal intubation could be relatively difficult in pediatric patients.…”

Visual aids for pediatric airway management

“…The DAS guidelines have had a significant impact, and as many as 14 other national or international guidelines have presented visual aids that use a similar design with only minor modifications . Only a few of them are intended for pediatric anesthesia …”

Comparative Evaluation of Difficult Intubation Predictors in Children Under Two Years of Ages

“…The difficult airway in children can quickly turn into a greatly serious situation that may lead to unfavorable and irreversible brain consequences that could even be life-threatening (2,4). Severe complications of the difficult airway include brain injury, cardiac arrest, and death (1,5,6) Pediatric patients have significant anatomical and physiological differences compared to adults, which affect the clinical judgment of the anesthesiologist to assess difficult airways (7,8). Difficult intubation in children compared to adults causes a rapid decrease in arterial oxygen saturation in children leading to a reduction in the opportunity for intubation (5).…”

“…Pediatric patients have significant anatomical and physiological differences compared to adults, which affect the clinical judgment of the anesthesiologist to assess difficult airways ( 7 , 8 ). Difficult intubation in children compared to adults causes a rapid decrease in arterial oxygen saturation in children leading to a reduction in the opportunity for intubation ( 5 ).…”