Assessment and management of the predicted difficult airway in neonates, infants and children

Abstract

Few scenarios in medicine incite as much apprehension as encountering a child with an anticipated or unanticipated difficult airway. Navigating the paediatric airway landscape necessitates not only precision but also a highly adaptable approach due to the unique anatomical and physiological challenges presented by neonates, infants, and children. This review highlights the critical importance of comprehensive preoperative evaluation, integrating detailed patient history, meticulous physical examinations, and previous medical records to predict potential airway difficulties accurately. Central to the management strategy is the development of a robust, adaptable plan that incorporates the use of both basic airway devices and advanced technological aids such as video-laryngoscopes and flexible bronchoscopes. These tools aim to enhance success rates while minimizing patient trauma. Axiomatic to this discussion is the formulation of strategies that effectively mitigate hypoxia and ensure successful airway control with minimal attempts. The review also addresses special considerations, such as the strategic management of difficult extubation and the application of algorithmic approaches to airway management, equipping practitioners to handle both anticipated and unanticipated challenges proficiently. By amalgamating and contextualizing insights from clinical practice and evidence-based recommendations, this review aims to arm healthcare providers with the knowledge and skills essential for optimizing paediatric airway management outcomes, thereby enhancing safety and efficacy in paediatric anaesthesia and critical care.