Difficult Airway Management in Pediatric Patients: Assessment and Strategies
Main Article Content
Keywords
airway management, endotracheal intubation, laringoscopy
Abstract
Significant anatomical and physiological distinctions exist between adults and children, particularly within the respiratory system. These disparities predispose pediatric patients to intricate airway management, where complications could lead to cerebral hypoxic injury, cardiac arrest, or fatality. Therefore, this article outlines essential insights into pediatric airway management, expounds upon the indispensable components of a focused assessment for timely recognition of risk factors contributing to difficult airway, and introduces dedicated algorithms tailored for this demographic. The overarching aim is to ensure an optimized approach to addressing this critical issue.
References
1. Alvarado M. Secuencia de intubación rápida en el Servicio de Emergencias: una revisión bibliográfica. Revista Ciencias de la salud. 2020;3(2):1-9.
2. Rodríguez J, Melo P, Enriquez D, Arteaga J, Garcia E, Higuita L. Frecuencia de Complicaciones en el Manejo de la vía Aérea: Revisión Sistemática de la Literatura. Archivos de Medicina. 2018;14(4):1-9. doi: 10.3823/1405
3. Apfelbaum J, Hagberg C, Connis R, Abdelmalak B, Agarkar M, Dutton R, Fiadjoe J, Greif R, Klock P, Mercier D, Myatra S, O’Sullivan E, Rosenblatt W, Sorbello M, Tung A. American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway. Anesthesiology. 2022;13(1):136-81 doi: https://doi.org/10.1097/ALN.0000000000004002
4. Miller K, Nagler J. Advances in Emergent Airway Management in Pediatrics. Emergency Medicine Clinics of North America. 2019;37(3):473-491. https://doi.org/10.1016/j.emc.2019.03.006
5. Rodrigez J, Melo P, Enriquez D, Arteaga J, Garcia E, Higuita L. Frecuencia de complicaciones en el manejo de la vía aérea: revisión sistemática de la literatura. Archivos de Medicina. 2018;14(4):1-9
6. Disma N, Kahn C, Butkovic D, Frelich D, Hansen M, Moja T et al. Difficult tracheal intubation in neonates and infants. NEonate and Children audiT of Anaesthesia pRactice IN Europe (NECTARINE): a prospective European multicentre observational study. British Journal of Anaesthesia. 2021;126(6):1173-81. DOI: 10.1016/j.bja.2021.02.021
7. Amaha E, Haddis L, Aweke S, Fenta E. The prevalence of difficult airway and its associated factors in pediatric patients who underwent surgery under general anesthesia: An observational study. SAGE Open Med. 2021;9:20-9. doi: 10.1177/20503121211052436
8. Fiadjoe JE, Nishisaki A, Jagannathan N, Hunyady AI, Greenberg RS, Reynolds PI, Matuszczak ME, Rehman MA, Polaner DM, Szmuk P, Nadkarni VM, McGowan FX Jr, Litman RS, Kovatsis PG. Airway management complications in children with difficult tracheal intubation from the Pediatric Difficult Intubation (PeDI) registry: a prospective cohort analysis. Lancet Respir Med. 2016 Jan;4(1):37-48. doi: 10.1016/S2213-2600(15)00508-1.
9. Rivera D, Diaz E. Vía aérea pediátrica. ¿Tan dificil como dicen? RevistaColombiana de Anestesiología. 2018;46(1): https://doi.org/10.1097/cj9.0000000000000046
10. Avva U, Lata JM, Kiel J. Airway Management. [Updated 2022 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Disponible en: https://www.ncbi.nlm.nih.gov/books/NBK470403/Vijayasekaran
11. Vijayasekaran S. Pediatric Airway Pathology. Front Pediatr. 2020 Jun 4;8:246. doi: 10.3389/fped.2020.00246
12. Jagannathan N, Asai T. Difficult airway management: children are different from adults, and neonates are different from children!. Brithish Jpurnal of Anaesthesia. 2021:126(6):1086-88 DOI:https://doi.org/10.1016/j.bja.2021.03.012
13. Wani T, Sissonnette B, Engelhardt T, Buchh B, Arnous H, AlGhamdi F, Tobias J. The pediatric airway: Historical concepts, new findings, and what matters. International Jpurnal of Pediatric Otorhinolaryngology. 2019;121:29-33 https://doi.org/10.1016/j.ijporl.2019.02.041
14. Krishna S, Bryant J, Tobias J. Management of the Difficult Airway in the Pediatric Patient. Journal of Pediatric Intensive Care. 2018 Sep;7(3):115-25. doi: 10.1055/s-0038-1624576.
15. Rivera D. Vía aérea pediátrica: ¿Hay novedades en su abordaje y tratamiento? Revista Colombiana de Anestesiología. 2020;49(2):1-8 doi: https://doi.org/10.5554/22562087.e945
16. Sanders JE, Spina LA. Supraglottic airway devices for pediatric airway management in the emergency department. Pediatr Emerg Med Pract. 2020 Oct;17(10):1-20 (https://pubmed.ncbi.nlm.nih.gov/33001595/)
17. Huang AS, Hajduk J, Rim C, Coffield S, Jagannathan N. Focused review on management of the difficult paediatric airway. Indian J Anaesth. 201;63(6):428-36. doi: 10.4103/ija.IJA_250_19
18. All India Difficult Airway Association. Guidelines for the management of untanticipated difficult trachea intubation un paediatrics [Internet]. 2016. [Citado el 22 de febrero de 2023]. Disponible en https://www.aidaa.in/aidaa_algorithms.html
19. Difficult airway society. Paediatric Difficult Airway Guidelines [Internet]. [Consultado el 23 de febrero de 2023]. Disponible en https://das.uk.com/guidelines/paediatric-difficult-airway-guidelines
20. Fiadjoe J, Nishisaki A. Normal and difficult airways in children: “What´s new”-current evidence. Pediatric Anesthesia. 2019;30(3):257-63. https://doi.org/10.1111/pan.13798.
2. Rodríguez J, Melo P, Enriquez D, Arteaga J, Garcia E, Higuita L. Frecuencia de Complicaciones en el Manejo de la vía Aérea: Revisión Sistemática de la Literatura. Archivos de Medicina. 2018;14(4):1-9. doi: 10.3823/1405
3. Apfelbaum J, Hagberg C, Connis R, Abdelmalak B, Agarkar M, Dutton R, Fiadjoe J, Greif R, Klock P, Mercier D, Myatra S, O’Sullivan E, Rosenblatt W, Sorbello M, Tung A. American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway. Anesthesiology. 2022;13(1):136-81 doi: https://doi.org/10.1097/ALN.0000000000004002
4. Miller K, Nagler J. Advances in Emergent Airway Management in Pediatrics. Emergency Medicine Clinics of North America. 2019;37(3):473-491. https://doi.org/10.1016/j.emc.2019.03.006
5. Rodrigez J, Melo P, Enriquez D, Arteaga J, Garcia E, Higuita L. Frecuencia de complicaciones en el manejo de la vía aérea: revisión sistemática de la literatura. Archivos de Medicina. 2018;14(4):1-9
6. Disma N, Kahn C, Butkovic D, Frelich D, Hansen M, Moja T et al. Difficult tracheal intubation in neonates and infants. NEonate and Children audiT of Anaesthesia pRactice IN Europe (NECTARINE): a prospective European multicentre observational study. British Journal of Anaesthesia. 2021;126(6):1173-81. DOI: 10.1016/j.bja.2021.02.021
7. Amaha E, Haddis L, Aweke S, Fenta E. The prevalence of difficult airway and its associated factors in pediatric patients who underwent surgery under general anesthesia: An observational study. SAGE Open Med. 2021;9:20-9. doi: 10.1177/20503121211052436
8. Fiadjoe JE, Nishisaki A, Jagannathan N, Hunyady AI, Greenberg RS, Reynolds PI, Matuszczak ME, Rehman MA, Polaner DM, Szmuk P, Nadkarni VM, McGowan FX Jr, Litman RS, Kovatsis PG. Airway management complications in children with difficult tracheal intubation from the Pediatric Difficult Intubation (PeDI) registry: a prospective cohort analysis. Lancet Respir Med. 2016 Jan;4(1):37-48. doi: 10.1016/S2213-2600(15)00508-1.
9. Rivera D, Diaz E. Vía aérea pediátrica. ¿Tan dificil como dicen? RevistaColombiana de Anestesiología. 2018;46(1): https://doi.org/10.1097/cj9.0000000000000046
10. Avva U, Lata JM, Kiel J. Airway Management. [Updated 2022 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Disponible en: https://www.ncbi.nlm.nih.gov/books/NBK470403/Vijayasekaran
11. Vijayasekaran S. Pediatric Airway Pathology. Front Pediatr. 2020 Jun 4;8:246. doi: 10.3389/fped.2020.00246
12. Jagannathan N, Asai T. Difficult airway management: children are different from adults, and neonates are different from children!. Brithish Jpurnal of Anaesthesia. 2021:126(6):1086-88 DOI:https://doi.org/10.1016/j.bja.2021.03.012
13. Wani T, Sissonnette B, Engelhardt T, Buchh B, Arnous H, AlGhamdi F, Tobias J. The pediatric airway: Historical concepts, new findings, and what matters. International Jpurnal of Pediatric Otorhinolaryngology. 2019;121:29-33 https://doi.org/10.1016/j.ijporl.2019.02.041
14. Krishna S, Bryant J, Tobias J. Management of the Difficult Airway in the Pediatric Patient. Journal of Pediatric Intensive Care. 2018 Sep;7(3):115-25. doi: 10.1055/s-0038-1624576.
15. Rivera D. Vía aérea pediátrica: ¿Hay novedades en su abordaje y tratamiento? Revista Colombiana de Anestesiología. 2020;49(2):1-8 doi: https://doi.org/10.5554/22562087.e945
16. Sanders JE, Spina LA. Supraglottic airway devices for pediatric airway management in the emergency department. Pediatr Emerg Med Pract. 2020 Oct;17(10):1-20 (https://pubmed.ncbi.nlm.nih.gov/33001595/)
17. Huang AS, Hajduk J, Rim C, Coffield S, Jagannathan N. Focused review on management of the difficult paediatric airway. Indian J Anaesth. 201;63(6):428-36. doi: 10.4103/ija.IJA_250_19
18. All India Difficult Airway Association. Guidelines for the management of untanticipated difficult trachea intubation un paediatrics [Internet]. 2016. [Citado el 22 de febrero de 2023]. Disponible en https://www.aidaa.in/aidaa_algorithms.html
19. Difficult airway society. Paediatric Difficult Airway Guidelines [Internet]. [Consultado el 23 de febrero de 2023]. Disponible en https://das.uk.com/guidelines/paediatric-difficult-airway-guidelines
20. Fiadjoe J, Nishisaki A. Normal and difficult airways in children: “What´s new”-current evidence. Pediatric Anesthesia. 2019;30(3):257-63. https://doi.org/10.1111/pan.13798.
Article Sidebar
Published
Sep 5, 2023
Article Details
How to Cite
Villafranco-Peña, D., Pacheco-Salas, M. P., Villarevia-Umaña, K., Chavarría-Núñez, K. F., & Alvarado-Arguedas, J. (2023). Difficult Airway Management in Pediatric Patients: Assessment and Strategies. Hispano-American Journal of Health Sciences, 9(2), 101–112. https://doi.org/10.56239/rhcs.2023.92.641
Section
Artiulos de Revision
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
RHCS uses the Creative Commons License 4.0 International (CC BY 4.0). For more information, please visit
Author Biographies
María Paula Pacheco-Salas, Universidad de Costa Rica. San José, Costa Rica.
Investigador independiente
Kevin Villarevia-Umaña, Universidad de Costa Rica. San José, Costa Rica.
Investigador Independiente
Katherine Fiorella Chavarría-Núñez, Universidad de Costa Rica. San José, Costa Rica
Investigador Independiente
José Alvarado-Arguedas, Universidad de Costa Rica. San José, Costa Rica.
Investigador Independiente