The difficult pediatric airway
- Nathan W Mick, MD
Nathan W Mick, MD
- Assistant Professor
- Tufts University School of Medical
- Section Editor
- Susan B Torrey, MD
Susan B Torrey, MD
- Section Editor — Pediatric Resuscitation; Pediatric Trauma
- Director, Division of Pediatric Emergency Medicine
- Associate Professor of Emergency Medicine and Pediatrics (Clinical)
- NYU School of Medicine
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — Adult and Pediatric Emergency Medicine
- Senior Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
Effective airway management includes anticipating and planning for problems. Difficulties frequently occur as the result of patient characteristics that interfere with spontaneous breathing, bag mask ventilation, laryngoscopy, and/or intubation of the trachea. Identifying characteristics of the difficult airway and developing a plan for managing problems are essential principles of anesthesia practice . These principles have been modified and effectively used to evaluate adults in the emergency department .
Children infrequently require aggressive airway management and difficulties do not occur often . As a result, evidence specific for children regarding identification and management of difficult airways is limited . Nevertheless, a reasonable, systematic approach for children can be developed from experience with adult patients in the operating room and emergency department.
This topic will review conditions in children that can make airway management difficult, anatomic characteristics that may identify those conditions, and management strategies. General principles of airway management in children, including rapid sequence intubation, and the adult with a difficult airway are discussed separately. (See "Basic airway management in children" and "Emergency endotracheal intubation in children" and "Rapid sequence intubation (RSI) in children" and "The difficult airway in adults".)
A difficult airway is generally defined as a situation in which a clinician experiences difficulty with face mask ventilation, laryngoscopy, or intubation [1,2]. In an emergency setting, this also includes difficulty performing an emergency surgical airway, such as needle cricothyroidotomy.
These difficulties may arise whenever any of the following maneuvers cannot be successfully performed:
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- CAUSES OF THE DIFFICULT PEDIATRIC AIRWAY
- Normal pediatric airway
- Congenital abnormalities
- Acquired conditions
- - Infection
- - Anaphylaxis
- - Trauma
- - Foreign body
- - Other causes
- IDENTIFICATION OF THE DIFFICULT PEDIATRIC AIRWAY
- Bag mask ventilation
- Laryngoscopy or intubation
- The LEMON© approach to difficult airway assessment
- ALTERNATIVE AIRWAY TECHNIQUES
- Laryngeal mask airway
- Intubating introducers (gum elastic bougie)
- Lighted stylet
- Fiberoptic stylets
- Flexible fiberoptic intubation
- Video laryngoscopy
- Surgical airway
- Supportive care
- Airway management
- - Crash airway
- - Rapid sequence intubation
- - Awake intubation
- - Alternative airway techniques
- Approach to the failed airway
- SUMMARY AND RECOMMENDATIONS