Airway management of difficult intubation in the pediatric population: A single center experience

Abstract

Awareness and the management of the difficult airway in children are crucial. Although the incidence of difficult intubation in children is believed to be lower than in adults, there is insufficient data regarding it. The aim of this study was to determine what airway management techniques are being applied in the difficult airway situation, by a group of experienced Consultant Anesthetists, in a large pediatric center. The study conducted over a 2-year period, in a large pediatric hospital. For a 2-year period beginning from September 2014, consultant anesthetists completed pro-forma following all pediatric anesthesia procedures in which tracheal intubation was difficult. The collected information included: patient demographics; airway assessment; anesthetic technique and airway management strategies employed; and reasons of failure in intubation attempts. There were 50 cases which were assessed as difficult intubation, and 80% of the cases had an anticipated difficult intubation report with 40% having a history of previous difficult intubation. Fiberoptic Bronchoscope (FOB) was the first-choice rescue technique in 84% of the patients; 92% of oral FOB and 71% of nasal FOB were successful. Six cases required surgical airway as surgical tracheostomy. This study created a screenshot of the various methods used when we were faced with a difficult airway management in pediatric population. Fiberoptic intubation remains overall the best method whereas no method was 100% successful. The majority of the patients had anticipated difficult airway, which opportunely allows planning for surgical airway with other teams such as Ear-Nose Throat and pediatric surgery.