Management of the Difficult Pediatric Airway
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AIRWAY MANAGEMENT (LC BERKOW, SECTION EDITOR)
Management of the Difficult Pediatric Airway Jacob Heninger 1 & Mitchell Phillips 1 & Andrea Huang 1 & Narasimhan Jagannathan 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review This review discusses the most current relevant literature regarding management of the difficult pediatric airway. Recent Findings Periodic review of the latest research ensures that anesthesia providers are educated on the most current practices. The review will provide practical evidence to support the use of various devices and techniques, including video laryngoscopy, flexible fiberoptic bronchoscopy, apneic oxygenation, use of neuromuscular blockade, ultrasound, and more. A simple algorithm for managing the difficult pediatric airway is also provided. Understanding the risk factors for the difficult pediatric airway, along with thorough preparation, will aid in reducing complications, which can be devastating. Summary Providers must maintain proficiency in the skills, both traditional and novel, required to effectively and safely manage the expected and unexpected difficult pediatric airway. Keywords Pediatric difficult airway management . Video laryngoscopy . Supraglottic airway device . Flexible fiberoptic bronchoscopy . Neuromuscular blockade . Apneic oxygenation
Introduction The pediatric difficult airway is one of the most challenging scenarios an anesthesia provider will encounter in their career. Fortunately, difficult intubation in children is less common when compared with the adult population. In a recent study looking at over 30,000 anesthetic procedures, the incidence of difficult tracheal intubation in the pediatric patient is 0.28% [1••]. It is essential for every anesthesia provider to know the risk factors for encountering a difficult airway and to have the skills to effectively manage it. The goal of this article is to This article is part of the Topical Collection on Airway Management * Narasimhan Jagannathan [email protected] Jacob Heninger [email protected] Mitchell Phillips [email protected] Andrea Huang [email protected] 1
Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
review the relevant literature regarding difficult airway management in the pediatric patient.
Airway Anatomy and Physiology The anatomical differences between the pediatric and adult airway can present unique challenges. These differences are most pronounced in children less than 1 year of age. The tongue of the pediatric patient is relatively larger compared with the oral cavity. This larger tongue can make it more difficult to perform laryngoscopy, as it may be challenging to displace the tongue and obtain an adequate view for successful tracheal intubation. The infant/neonate also has a prominent occiput that is significantly larger relative to the patient’s body size. Both of these anato
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