Use of ultrasound in pediatric airway: Revisiting the past, reviewing the present, and recommending for the future

Despite few inherent issues, ultrasound (US) has emerged as a new frontier in the assessment and management of pediatric airway due to easy availability of US machines in operation theaters, noninvasive and radiation-free properties, and reproducibility. In this narrative review, we discussed the ergonomics and equipment needed to perform the airway scan, types of scans performed and their clinical applications, normal appearance of airway structures, and important clinical applications of US in the management of pediatric airway. The greatest advantage of US lies in accurate location of cricothyroid membrane and tracheal rings, in measuring the narrowest part of the airway (cricoid) to determine the size of the endotracheal tube, to rule out esophageal intubation, and in assessing the movements of the vocal cords, among others. In our view, upper airway US is a convenient, cost-effective, noninvasive, first-line airway assessment tool which is dynamic in nature. It can be used preoperatively, intraoperatively for real-time guidance in performing interventional procedures, and in the postoperative period.