Managing the challenging pediatric airway: Continuing Professional Development

Cengiz Karsli

This module will give the anesthesia provider the information needed to identify, prepare for, and clinically manage a difficult airway in children. Although the incidence of difficult intubation is lower in children than in adults, the anesthesiologist who even occasionally cares for children must be prepared to manage the pediatric patient with a known or suspected difficult airway. Many of the predictors of a difficult intubation that are useful in adults do not apply to children. Predictably, many children with a challenging airway also have a syndrome or diagnosis known to be associated with difficult intubation. Due to the unique emotional, physiological, and anatomical characteristics of small children, the approach to airway management is different from that in adults. Awake intubation is almost never an option, and recently, there has been a trend towards using cuffed tracheal tubes and apneic intubation. The flexible fibrescope has seen less action as the sole intubating device with the recent introduction of the various video laryngoscopes designed for pediatric use. Supraglottic airways are now being used in children with a difficult airway, not only as a rescue device in the event of failed intubation but also as a first-choice airway device and as a conduit for tracheal intubation. Although direct laryngoscopy can still be used to manage the care of the majority of children with a known or suspected challenging airway, there is now a noticeable trend towards the use of a supraglottic airway and apneic intubation using fibreoptic and video laryngoscopic equipment.