The normal and the challenging pediatric airway

Abstract

Management of a child's airway is one of the main sources of stress for anesthetists who do not routinely anesthetize children. Unfortunately, trainees are gaining less experience in pediatric airway management than in the past, which is particularly difficult at a time when some beliefs about airway management are being challenged and airway management is less standardized. Fortunately, most children have an easily managed, normal airway. Nevertheless, it is of vital importance to teach our trainees the basic airway skills that are probably the most important skill in an anesthetists' repertoire when it comes to a difficult airway situation. This review focuses on the airway management in children with a normal and a challenging airway. Different choices of airway management in children, and their advantages and disadvantages are discussed. Furthermore, the three broad causes of a challenging airway in children and infants are highlighted - the difficulty obtaining a mask seal, difficulty visualizing the vocal cords, and the third cause in which the larynx can be visualized but the difficulty lies at or beyond that level. Guidelines are given how to deal with these patients as well as with the feared but rare scenario of 'cannot ventilate, cannot intubate' in children.

Careful Planning in a Pediatric Expected Difficult Airway in a Specialized Tertiary Hospital: What can Go Wrong? A Case Report

“…Difficulties were anticipated based on the physical exam and a record of a "strange and difficult" airway in a previous intubation by video-laryngoscopy with the additional information of no airway deformities in a nasofibroscopy performed after that episode. Based on the existing literature, there is not a clear recommendation about which technique should preferably be used in which entity or at which age [1][2][3]. The use of a supraglotic device to secure the airway during surgery was not an option considering the scheduled surgery.…”

“…As we can see in this particular case, incomplete records and improper allocation of information may influence key decisions in the planning process. Otherwise, the most likely option in this case would be fiberoptic intubation through laryngeal mask to have shorter access to the vocal cords while keeping spontaneous breathing [2,3]. Even though, the lack of a suction channel in the fiberscope may pose important obstacles to a successful intubation.…”

“…Based on the existing literature, there´s not a clear recommendation about which technique should preferably be used in which entity or at which age. However, maintenance of spontaneous breathing until definitive airway is secured as well as the use of flexible endoscopes is frequently suggested as the preferred technique in children with expected difficult airways [1][2][3]. Despite the recognition that video-laryngoscopes can be generally effective in the management of difficult airways in children, the definitive value of these devices is not currently clearly defined [2,3].…”

“…Even though there are some recommendations about the pediatric expected difficult airway and airway management in children with facial abnormalities that we should have in mind [1][2][3]. Based on the existing literature, there´s not a clear recommendation about which technique should preferably be used in which entity or at which age.…”

Anaesthetic Challenges in A Patient with Massive Lipoma Neck: Lateral Intubation A Salvage Technique

“…These children pose a challenge as though laryngoscopy maybe straightforward but problem lies at the vocal cords or beyond where the airway may be compromised due to pressure effects of a long standing swelling. 1 We describe the challenges incurred in our case where the technique of lateral intubation proved to be a boon. To the best of our knowledge and extensive search of literature, this technique has rarely been reported in paediatric patients for a huge anterior neck mass.…”