The difficult pediatric airway: Predictors, incidence, and complications

Airway and respiratory complications are frequent causes of anesthetic-related morbidity in the pediatric patient. Often, these complications occur in patients who are difficult to mask-ventilate, intubate, or manage with a supraglottic airway (SGA) device. While not all challenging airways can be identified preoperatively, recognizing anatomical features predictive of difficult intubation will facilitate preparation and enhance safety. When faced with the anticipated difficult airway, the anesthesiologist may change his or her plan for induction and ventilation, prepare additional airway equipment and emergency medications, and have extra help available for the airway management. This likely explains the lower complication rates seen with the management of anticipated versus unanticipated difficult airways. In addition to identifying the potentially difficult airway, understanding the most common airway complications, their risk factors, and strategies for prevention and treatment are vital components of safe pediatric airway management.