Purpose of Review
The goal of this paper is to review key concepts in the management of the pediatric difficult airway. Early recognition of risk factors and thorough preparation may be helpful in reducing the risk of complications during airway management.
Management of difficult pediatric airway management may be associated with a high rate of complications. It is important that clinicians understand the patient profiles associated with difficult airway management and the equipment and techniques available to effectively manage these children. Airway ultrasonography and apneic oxygenation are novel techniques that have been increasingly utilized for their potential to improve safety during difficult airway management and will be briefly discussed in this review.
This review will highlight key current concepts in the management of the difficult pediatric airway.
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•• Engelhardt T, Virag K, Veyckemans F, Habre W, Network AGotESoACT. Airway management in paediatric anaesthesia in Europe-insights from APRICOT (Anaesthesia Practice In Children Observational Trial): a prospective multicentre observational study in 261 hospitals in Europe. Br J Anaesth. 2018;121(1):66–75. https://doi.org/10.1016/j.bja.2018.04.013Airway management practices vary widely across Europe. Multiple airway device insertion attempts and pre-existing respiratory risk factors increase the likelihood of critical respiratory events in children and require further stratification during preoperative assessment and planning. This study highlights areas where education, research, and training may improve perioperative care.
Valois-Gomez T, Oofuvong M, Auer G, Coffin D, Loetwiriyakul W, Correa JA. Incidence of difficult bag-mask ventilation in children: a prospective observational study. Paediatr Anaesth. 2013;23(10):920–6. https://doi.org/10.1111/pan.12144.
Kheterpal S, Martin L, Shanks AM, Tremper KK. Prediction and outcomes of impossible mask ventilation: a review of 50,000 anesthetics. Anesthesiology. 2009;110(4):891–7. https://doi.org/10.1097/ALN.0b013e31819b5b87.
Langeron O, Masso E, Huraux C, Guggiari M, Bianchi A, Coriat P, et al. Prediction of difficult mask ventilation. Anesthesiology. 2000;92(5):1229–36.
•• Fiadjoe JE, Nishisaki A, Jagannathan N, Hunyady AI, Greenberg RS, Reynolds PI, et al. Airway management complications in children with difficult tracheal intubation from the Pediatric Difficult Intubation (PeDI) registry: a prospective cohort analysis. Lancet Respir Med. 2016;4(1):37–48. https://doi.org/10.1016/S2213-2600(15)00508-1More than two direct laryngoscopy attempts in children with difficult tracheal intubation are associated with a high failure rate and an increased incidence of severe complications. These results suggest that limiting the number of direct laryngoscopy attempts and quickly transitioning to an indirect technique when direct laryngoscopy fails would enhance patient safety.
Frei FJ, Ummenhofer W. Difficult intubation in paediatrics. Paediatr Anaesth. 1996;6(4):251–63.
Holm-Knudsen RJ, Rasmussen LS. Paediatric airway management: basic aspects. Acta Anaesthesiol Scand. 2009;53(1):1–9. https://doi.org/10.1111/j.1399-6576.2008.01794.x.
Morray JP, Geiduschek JM, Caplan RA, Posner KL, Gild WM, Cheney FW. A comparison of pediatric and adult anesthesia closed malpractice claims. Anesthesiology. 1993;78(3):461–7.
Frawley G, Espenell A, Howe P, Shand J, Heggie A. Anesthetic implications of infants with mandibular hypoplasia treated with mandibular distraction osteogenesis. Paediatr Anaesth. 2013;23(4):342–8. https://doi.org/10.1111/pan.12049.
Hosking J, Zoanetti D, Carlyle A, Anderson P, Costi D. Anesthesia for Treacher Collins syndrome: a review of airway management in 240 pediatric cases. Paediatr Anaesth. 2012;22(8):752–8. https://doi.org/10.1111/j.1460-9592.2012.03829.x.
Sims C, von Ungern-Sternberg BS. The normal and the challenging pediatric airway. Paediatr Anaesth. 2012;22(6):521–6. https://doi.org/10.1111/j.1460-9592.2012.03858.x.
Lerman J, Coté CJ, Steward DJ. Manual of Pediatric Anesthesia. Springer International Publishing; 2016.
Hardman JG, Wills JS. The development of hypoxaemia during apnoea in children: a computational modelling investigation. Br J Anaesth. 2006;97(4):564–70. https://doi.org/10.1093/bja/ael178.
Humphreys S, Lee-Archer P, Reyne G, Long D, Williams T, Schibler A. Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) in children: a randomized controlled trial. Br J Anaesth. 2017;118(2):232–8. https://doi.org/10.1093/bja/aew401.
Bhananker SM, Ramamoorthy C, Geiduschek JM, Posner KL, Domino KB, Haberkern CM, et al. Anesthesia-related cardiac arrest in children: update from the Pediatric Perioperative Cardiac Arrest Registry. Anesth Analg. 2007;105(2):344–50. https://doi.org/10.1213/01.ane.0000268712.00756.dd.
Langeron O, Bourgain JL, Francon D, Amour J, Baillard C, Bouroche G, et al. Difficult intubation and extubation in adult anaesthesia. Anaesth Crit Care Pain Med. 2018;37(6):639–51. https://doi.org/10.1016/j.accpm.2018.03.013.
Sheeran PW, Walsh BK, Finley AM, Martin AK, Brenski AC. Management of difficult airway patients and the use of a difficult airway registry at a tertiary care pediatric hospital. Paediatr Anaesth. 2014;24(8):819–24. https://doi.org/10.1111/pan.12356.
Apfelbaum JL, Hagberg CA, Caplan RA, Blitt CD, Connis RT, Nickinovich DG, et al. Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology. 2013;118(2):251–70. https://doi.org/10.1097/ALN.0b013e31827773b2.
Frerk C, Mitchell VS, McNarry AF, Mendonca C, Bhagrath R, Patel A, et al. Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults. Br J Anaesth. 2015;115(6):827–48. https://doi.org/10.1093/bja/aev371.
Law JA, Broemling N, Cooper RM, Drolet P, Duggan LV, Griesdale DE, et al. The difficult airway with recommendations for management--part 1--difficult tracheal intubation encountered in an unconscious/induced patient. Can J Anaesth. 2013;60(11):1089–118. https://doi.org/10.1007/s12630-013-0019-3.
Habre W, Disma N, Virag K, Becke K, Hansen TG, Johr M, et al. Incidence of severe critical events in paediatric anaesthesia (APRICOT): a prospective multicentre observational study in 261 hospitals in Europe. Lancet Respir Med. 2017;5(5):412–25. https://doi.org/10.1016/S2213-2600(17)30116-9.
Weiss M, Engelhardt T. Cannot ventilate--paralyze! Paediatr Anaesth. 2012;22(12):1147–9. https://doi.org/10.1111/pan.12054.
Cook TM, Silsby J, Simpson TP. Airway rescue in acute upper airway obstruction using a ProSeal laryngeal mask airway and an Aintree catheter: a review of the ProSeal laryngeal mask airway in the management of the difficult airway. Anaesthesia. 2005;60(11):1129–36. https://doi.org/10.1111/j.1365-2044.2005.04370.x.
Jagannathan N, Wong DT. Successful tracheal intubation through an intubating laryngeal airway in pediatric patients with airway hemorrhage. J Emerg Med. 2011;41(4):369–73. https://doi.org/10.1016/j.jemermed.2010.05.066.
Sohn L, Sawardekar A, Jagannathan N. Airway management options in a prone achondroplastic dwarf with a difficult airway after unintentional tracheal extubation during a wake-up test for spinal fusion: to flip or not to flip? Can J Anaesth. 2014;61(8):741–4. https://doi.org/10.1007/s12630-014-0182-1.
Timmermann A. Supraglottic airways in difficult airway management: successes, failures, use and misuse. Anaesthesia. 2011;66(Suppl 2):45–56. https://doi.org/10.1111/j.1365-2044.2011.06934.x.
Jagannathan N, Sequera-Ramos L, Sohn L, Wallis B, Shertzer A, Schaldenbrand K. Elective use of supraglottic airway devices for primary airway management in children with difficult airways. Br J Anaesth. 2014;112(4):742–8. https://doi.org/10.1093/bja/aet411.
Bolton P. Emergency jet ventilation in children. Paediatr Anaesth. 2009;19(5):425–7. https://doi.org/10.1111/j.1460-9592.2009.02994.x.
Black AE, Flynn PE, Smith HL, Thomas ML, Wilkinson KA, Association of Pediatric Anaesthetists of Great B, et al. Development of a guideline for the management of the unanticipated difficult airway in pediatric practice. Paediatr Anaesth. 2015;25(4):346–62. https://doi.org/10.1111/pan.12615.
Depierraz B, Ravussin P, Brossard E, Monnier P. Percutaneous transtracheal jet ventilation for paediatric endoscopic laser treatment of laryngeal and subglottic lesions. Can J Anaesth. 1994;41(12):1200–7.
Sabato SC, Long E. An institutional approach to the management of the “Can’t intubate, Can’t Oxygenate” emergency in children. Paediatr Anaesth. 2016;26(8):784–93. https://doi.org/10.1111/pan.12926.
Navsa N, Tossel G, Boon JM. Dimensions of the neonatal cricothyroid membrane - how feasible is a surgical cricothyroidotomy? Paediatr Anaesth. 2005;15(5):402–6. https://doi.org/10.1111/j.1460-9592.2005.01470.x.
Koers L, Janjatovic D, Stevens MF, Preckel B. The emergency paediatric surgical airway: a systematic review. Eur J Anaesthesiol. 2018;35(8):558–65. https://doi.org/10.1097/EJA.0000000000000813.
Park R, Peyton JM, Fiadjoe JE, Hunyady AI, Kimball T, Zurakowski D, et al. The efficacy of GlideScope(R) videolaryngoscopy compared with direct laryngoscopy in children who are difficult to intubate: an analysis from the paediatric difficult intubation registry. Br J Anaesth. 2017;119(5):984–92. https://doi.org/10.1093/bja/aex344.
Cooper RM, Pacey JA, Bishop MJ, McCluskey SA. Early clinical experience with a new videolaryngoscope (GlideScope) in 728 patients. Can J Anaesth. 2005;52(2):191–8.
Fiadjoe JE, Gurnaney H, Dalesio N, Sussman E, Zhao H, Zhang X, et al. A prospective randomized equivalence trial of the GlideScope Cobalt(R) video laryngoscope to traditional direct laryngoscopy in neonates and infants. Anesthesiology. 2012;116(3):622–8. https://doi.org/10.1097/ALN.0b013e318246ea4d.
Kim JT, Na HS, Bae JY, Kim DW, Kim HS, Kim CS, et al. GlideScope video laryngoscope: a randomized clinical trial in 203 paediatric patients. Br J Anaesth. 2008;101(4):531–4. https://doi.org/10.1093/bja/aen234.
Lee JH, Park YH, Byon HJ, Han WK, Kim HS, Kim CS, et al. A comparative trial of the GlideScope(R) video laryngoscope to direct laryngoscope in children with difficult direct laryngoscopy and an evaluation of the effect of blade size. Anesth Analg. 2013;117(1):176–81. https://doi.org/10.1213/ANE.0b013e318292f0bf.
Mutlak H, Rolle U, Rosskopf W, Schalk R, Zacharowski K, Meininger D, et al. Comparison of the TruView infant EVO2 PCD and C-MAC video laryngoscopes with direct Macintosh laryngoscopy for routine tracheal intubation in infants with normal airways. Clinics (Sao Paulo). 2014;69(1):23–7. https://doi.org/10.6061/clinics/2014(01)04.
Riveros R, Sung W, Sessler DI, Sanchez IP, Mendoza ML, Mascha EJ, et al. Comparison of the Truview PCD and the GlideScope((R)) video laryngoscopes with direct laryngoscopy in pediatric patients: a randomized trial. Can J Anaesth. 2013;60(5):450–7. https://doi.org/10.1007/s12630-013-9906-x.
Vlatten A, Aucoin S, Litz S, Macmanus B, Soder C. A comparison of the STORZ video laryngoscope and standard direct laryngoscopy for intubation in the pediatric airway--a randomized clinical trial. Paediatr Anaesth. 2009;19(11):1102–7. https://doi.org/10.1111/j.1460-9592.2009.03127.x.
•• Burjek NE, Nishisaki A, Fiadjoe JE, Adams HD, Peeples KN, Raman VT, et al. Videolaryngoscopy versus fiber-optic intubation through a supraglottic airway in children with a difficult airway: an analysis from the multicenter pediatric difficult intubation registry. Anesthesiology. 2017;127(3):432–40. https://doi.org/10.1097/ALN.0000000000001758Fiber-optic intubation via supraglottic airway is associated with higher first-attempt success than videolaryngoscopy in infants with difficult airways. Continuous ventilation through the supraglottic airway during fiber-optic intubation attempts may lower the incidence of hypoxemia.
Greer D, Marshall KE, Bevans S, Standlee A, McAdams P, Harsha W. Review of videolaryngoscopy pharyngeal wall injuries. Laryngoscope. 2017;127(2):349–53. https://doi.org/10.1002/lary.26134.
Asai T, Nagata A, Shingu K. Awake tracheal intubation through the laryngeal mask in neonates with upper airway obstruction. Paediatr Anaesth. 2008;18(1):77–80. https://doi.org/10.1111/j.1460-9592.2007.02354.x.
Heard CM, Caldicott LD, Fletcher JE, Selsby DS. Fiberoptic-guided endotracheal intubation via the laryngeal mask airway in pediatric patients: a report of a series of cases. Anesth Analg. 1996;82(6):1287–9.
Walker RW. The laryngeal mask airway in the difficult paediatric airway: an assessment of positioning and use in fibreoptic intubation. Paediatr Anaesth. 2000;10(1):53–8.
Walker RW, Allen DL, Rothera MR. A fibreoptic intubation technique for children with mucopolysaccharidoses using the laryngeal mask airway. Paediatr Anaesth. 1997;7(5):421–6.
Jagannathan N, Jagannathan R. Prone insertion of a size 0.5 intubating laryngeal airway overcomes severe upper airway obstruction in an awake neonate with Pierre Robin syndrome. Can J Anaesth. 2012;59(10):1001–2. https://doi.org/10.1007/s12630-012-9766-9.
Mathis MR, Haydar B, Taylor EL, Morris M, Malviya SV, Christensen RE, et al. Failure of the laryngeal mask airway unique and classic in the pediatric surgical patient: a study of clinical predictors and outcomes. Anesthesiology. 2013;119(6):1284–95. https://doi.org/10.1097/ALN.0000000000000015.
Kleine-Brueggeney M, Gottfried A, Nabecker S, Greif R, Book M, Theiler L. Pediatric supraglottic airway devices in clinical practice: a prospective observational study. BMC Anesthesiol. 2017;17(1):119. https://doi.org/10.1186/s12871-017-0403-6.
Kleine-Brueggeney M, Nicolet A, Nabecker S, Seiler S, Stucki F, Greif R, et al. Blind intubation of anaesthetised children with supraglottic airway devices AmbuAura-i and Air-Q cannot be recommended: a randomised controlled trial. Eur J Anaesthesiol. 2015;32(9):631–9. https://doi.org/10.1097/EJA.0000000000000261.
Jagannathan N, Kozlowski RJ, Sohn LE, Langen KE, Roth AG, Mukherji II, et al. A clinical evaluation of the intubating laryngeal airway as a conduit for tracheal intubation in children. Anesth Analg. 2011;112(1):176–82. https://doi.org/10.1213/ANE.0b013e3181fe0408.
Kovatsis PG. Continuous ventilation during flexible fiberscopic-assisted intubation via supraglottic airways. Paediatr Anaesth. 2016;26(4):457–8. https://doi.org/10.1111/pan.12863.
Sohn LE, Jagannathan N, Sequera-Ramos L, Sawardekar A, Schaldenbrand K, De Oliveira GS. A randomised comparison of free-handed vs air-Q assisted fibreoptic-guided tracheal intubation in children < 2 years of age. Anaesthesia. 2014;69(7):723–8. https://doi.org/10.1111/anae.12667.
Jagannathan N, Sohn LE, Eidem JM. Use of the air-Q intubating laryngeal airway for rapid-sequence intubation in infants with severe airway obstruction: a case series. Anaesthesia. 2013;68(6):636–8. https://doi.org/10.1111/anae.12230.
Stricker PA, Budac S, Fiadjoe JE, Rehman MA. Awake laryngeal mask insertion followed by induction of anesthesia in infants with the Pierre Robin sequence. Acta Anaesthesiol Scand. 2008;52(9):1307–8. https://doi.org/10.1111/j.1399-6576.2008.01751.x.
Jagannathan N, Truong CT. A simple method to deliver pharyngeal anesthesia in syndromic infants prior to awake insertion of the intubating laryngeal airway. Can J Anaesth. 2010;57(12):1138–9. https://doi.org/10.1007/s12630-010-9394-1.
Holm-Knudsen R, Eriksen K, Rasmussen LS. Using a nasopharyngeal airway during fiberoptic intubation in small children with a difficult airway. Paediatr Anaesth. 2005;15(10):839–45. https://doi.org/10.1111/j.1460-9592.2004.01566.x.
Holmdahl MH. Pulmonary uptake of oxygen, acid-base metabolism, and circulation during prolonged apnoea. Acta Chir Scand Suppl. 1956;212:1–128.
Steiner JW, Sessler DI, Makarova N, Mascha EJ, Olomu PN, Zhong JW, et al. Use of deep laryngeal oxygen insufflation during laryngoscopy in children: a randomized clinical trial. Br J Anaesth. 2016;117(3):350–7. https://doi.org/10.1093/bja/aew186.
Bazuaye EA, Stone TN, Corris PA, Gibson GJ. Variability of inspired oxygen concentration with nasal cannulas. Thorax. 1992;47(8):609–11.
Olayan L, Alatassi A, Patel J, Milton S. Apnoeic oxygenation by nasal cannula during airway management in children undergoing general anaesthesia: a pilot randomised controlled trial. Perioper Med (Lond). 2018;7:3. https://doi.org/10.1186/s13741-018-0083-x.
• Riva T, Pedersen TH, Seiler S, Kasper N, Theiler L, Greif R, et al. Transnasal humidified rapid insufflation ventilatory exchange for oxygenation of children during apnoea: a prospective randomised controlled trial. Br J Anaesth. 2018;120(3):592–9. https://doi.org/10.1016/j.bja.2017.12.017High-flow 100% oxygen (2 litres kg-1 min-1) administered via nasal cannulas did not extend the safe apnoea time for children weighing 10–20 kg compared with low-flow nasal cannula oxygen (0.2 litres kg-1 min-1). No ventilatory effect was observed with THRIVE at 2.0 litres kg-1 min-.
Jagannathan N, Burjek N. Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) in children: a step forward in apnoeic oxygenation, paradigm-shift in ventilation, or both? Br J Anaesth. 2017;118(2):150–2. https://doi.org/10.1093/bja/aew432.
Manley BJ, Dold SK, Davis PG, Roehr CC. High-flow nasal cannulae for respiratory support of preterm infants: a review of the evidence. Neonatology. 2012;102(4):300–8. https://doi.org/10.1159/000341754.
Riva T, Seiler S, Stucki F, Greif R, Theiler L. High-flow nasal cannula therapy and apnea time in laryngeal surgery. Paediatr Anaesth. 2016;26(12):1206–8. https://doi.org/10.1111/pan.12992.
Nishimura M. High-flow nasal cannula oxygen therapy in adults. J Intensive Care. 2015;3(1):15. https://doi.org/10.1186/s40560-015-0084-5.
Wing R, James C, Maranda LS, Armsby CC. Use of high-flow nasal cannula support in the emergency department reduces the need for intubation in pediatric acute respiratory insufficiency. Pediatr Emerg Care. 2012;28(11):1117–23. https://doi.org/10.1097/PEC.0b013e31827122a9.
Humphreys S, Rosen D, Housden T, Taylor J, Schibler A. Nasal high-flow oxygen delivery in children with abnormal airways. Paediatr Anaesth. 2017;27(6):616–20. https://doi.org/10.1111/pan.13151.
McCormack JG, Krosnar S, Baxter A. Reply to “Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) in children: a randomized controlled trial”. Br J Anaesth. 2017;119(1):172. https://doi.org/10.1093/bja/aex160.
Patel A, Nouraei SA. Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE): a physiological method of increasing apnoea time in patients with difficult airways. Anaesthesia. 2015;70(3):323–9. https://doi.org/10.1111/anae.12923.
Frumin MJ, Epstein RM, Cohen G. Apneic oxygenation in man. Anesthesiology. 1959;20:789–98.
Kristensen MS, Teoh WH, Graumann O, Laursen CB. Ultrasonography for clinical decision-making and intervention in airway management: from the mouth to the lungs and pleurae. Insights Imaging. 2014;5(2):253–79. https://doi.org/10.1007/s13244-014-0309-5.
Marciniak B, Fayoux P, Hebrard A, Krivosic-Horber R, Engelhardt T, Bissonnette B. Airway management in children: ultrasonography assessment of tracheal intubation in real time? Anesth Analg. 2009;108(2):461–5. https://doi.org/10.1213/ane.0b013e31819240f5.
•• Stafrace S, Engelhardt T, Teoh WH, Kristensen MS. Essential ultrasound techniques of the pediatric airway. Paediatr Anaesth. 2016;26(2):122–31. https://doi.org/10.1111/pan.12787Ultrasound of the airways is a technique which has been described in a number of recent articles and reviews highlighting the diagnostic possibilities and simple methodology. This review article gives a general overview of the equipment considerations, scanning protocols, and clinical applications of airway ultrasound in children.
Fiadjoe JE, Stricker P, Gurnaney H, Nishisaki A, Rabinowitz A, Gurwitz A, et al. Ultrasound-guided tracheal intubation: a novel intubation technique. Anesthesiology. 2012;117(6):1389–91. https://doi.org/10.1097/ALN.0b013e3182746a30.
Dennington D, Vali P, Finer NN, Kim JH. Ultrasound confirmation of endotracheal tube position in neonates. Neonatology. 2012;102(3):185–9. https://doi.org/10.1159/000338585.
Mora-Matilla M, Alonso-Quintela P, Oulego-Erroz I, Rodriguez-Blanco S, Gautreaux-Minaya S, Mata-Zubillaga D. Is ultrasound a feasible tool to verify endotracheal tube position in neonates? Resuscitation. 2013;84(1):e19–20. https://doi.org/10.1016/j.resuscitation.2012.09.026.
Lakhal K, Delplace X, Cottier JP, Tranquart F, Sauvagnac X, Mercier C, et al. The feasibility of ultrasound to assess subglottic diameter. Anesth Analg. 2007;104(3):611–4. https://doi.org/10.1213/01.ane.0000260136.53694.fe.
Schramm C, Knop J, Jensen K, Plaschke K. Role of ultrasound compared to age-related formulas for uncuffed endotracheal intubation in a pediatric population. Paediatr Anaesth. 2012;22(8):781–6. https://doi.org/10.1111/j.1460-9592.2012.03889.x.
Shibasaki M, Nakajima Y, Ishii S, Shimizu F, Shime N, Sessler DI. Prediction of pediatric endotracheal tube size by ultrasonography. Anesthesiology. 2010;113(4):819–24. https://doi.org/10.1097/ALN.0b013e3181ef6757.
Hardee PS, Ng SY, Cashman M. Ultrasound imaging in the preoperative estimation of the size of tracheostomy tube required in specialised operations in children. Br J Oral Maxillofac Surg. 2003;41(5):312–6.
Kerrey BT, Geis GL, Quinn AM, Hornung RW, Ruddy RM. A prospective comparison of diaphragmatic ultrasound and chest radiography to determine endotracheal tube position in a pediatric emergency department. Pediatrics. 2009;123(6):e1039–44. https://doi.org/10.1542/peds.2008-2828.
Milling TJ, Jones M, Khan T, Tad-y D, Melniker LA, Bove J, et al. Transtracheal 2-d ultrasound for identification of esophageal intubation. J Emerg Med. 2007;32(4):409–14. https://doi.org/10.1016/j.jemermed.2006.08.022.
Tsung JW, Fenster D, Kessler DO, Novik J. Dynamic anatomic relationship of the esophagus and trachea on sonography: implications for endotracheal tube confirmation in children. J Ultrasound Med. 2012;31(9):1365–70.
Abbasi S, Farsi D, Zare MA, Hajimohammadi M, Rezai M, Hafezimoghadam P. Direct ultrasound methods: a confirmatory technique for proper endotracheal intubation in the emergency department. Eur J Emerg Med. 2015;22(1):10–6. https://doi.org/10.1097/MEJ.0000000000000108.
Oulego-Erroz I, Alonso-Quintela P, Rodriguez-Blanco S, Mata-Zubillaga D, Fernandez-Miaja M. Verification of endotracheal tube placement using ultrasound during emergent intubation of a preterm infant. Resuscitation. 2012;83(6):e143–4. https://doi.org/10.1016/j.resuscitation.2012.02.014.
Sethi A, Nimbalkar A, Patel D, Kungwani A, Nimbalkar S. Point of care ultrasonography for position of tip of endotracheal tube in neonates. Indian Pediatr. 2014;51(2):119–21.
Vats A, Worley GA, de Bruyn R, Porter H, Albert DM, Bailey CM. Laryngeal ultrasound to assess vocal fold paralysis in children. J Laryngol Otol. 2004;118(6):429–31. https://doi.org/10.1258/002221504323219545.
Conflict of Interest
Michelle Tsao declares that she has no conflict of interest.
Andrew Wuenstel declares that he has no conflict of interest.
Brian Zider declares that he has no conflict of interest.
John Hajduk declares that he has no conflict of interest.
Narasimhan Jagannathan has served on medical advisory boards for Vyaire Medical and Salter Labs and serves on the Editorial Boards of Anesthesia & Analgesia, Pediatric Anesthesia, Journal of Clinical Anesthesia, and Journal of Anesthesia.
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Tsao, M., Wuenstel, A., Zider, B. et al. Current Concepts in the Management of the Difficult Pediatric Airway. Curr Anesthesiol Rep 9, 123–134 (2019). https://doi.org/10.1007/s40140-019-00319-y
- Pediatric difficult airway management
- Airway ultrasound
- Apneic oxygenation