Pediatric airway: as difficult as they say?

  • Daniel Rivera-Tocancipá Anaesthesiology Service, Hospital Universitario Hernando Moncaleano Perdomo, Universidad Surcolombiana. Neiva, Colombia.
  • Elizabeth Díaz-Sánchez Anaesthesiology Service, Clínica EMCOSALUD. Neiva, Colombia
Keywords: Airway Management, Anesthesiologists, Pediatrics, Intubation, Intratracheal, Laryngoscopy


This article is addressed to those anesthetists who are occasionally faced with pediatric patients, and the anxiety and stress created by the fear of failure in the management of the airway. It aims to present specific concepts for approaching the airway safely.

The article describes the importance of adequate airway management in pediatrics; relevant differences with respect to adults; the details of the new classification of the pediatric airway proposed since 2012; and important aspects of the existing airway management algorithms. Considerations that may become a source of failure in securing the airway are pointed out, thoughts about each topic are presented, and conclusions are provided.


1. Valois-Gómez T, Oofuvong M, Auer G, Coffin D, Loetwiriyakul W, Correa JA. Incidence of difficult bag-mask ventilation in children: a prospective observational study. Pediatr Anesth 2013;23:920-926.

2. Cook TM, Woodall N, Harper J, Benger J. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Br J Anaesth 2011;106:632-642.

3. Apfelbaum JL, Hagberg CA, Caplan RA, Blitt C, Connis RT, Nickinovich D, 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;118:251-270.

4. Gooden CK. An Update on Pediatric Airway Management. Int Anesthesiol Clin 2017;55:86-96.

5. Ramachandran SK, Klock PA. Definition and Incidence of the Difficult Airway. Third Edit. 2012;Benumof and Hagberg's Airway Management, Elsevier Inc:201-208.

6. Navaratnarajah J, Black AE. Assessment and management of the predicted difficult airway in babies and children. Anaesth Intensive Care Med 2012;13:226-233.

7. Mick NW. Airway management in patients with abnormal anatomy or challenging physiology. Clin Pediatr Emerg Med 2015;16:186-194.

8. Lerman J. What makes the pediatric airway so difficult? Rev Mex Anestesiol 2016;39 (supl 1):294-296.

9. Ríos Á, Gomez LM, Aguirre O, Ocampo F. La vía aérea pediátrica: algunos conceptos para tener en cuenta en el manejo anestésico. Rev Colomb Anestesiol 2012;40:199-202.

10. Litman RS, Weissend EE, Shibata D, Westesson P. Developmental changes of laryngeal dimensions in unparalyzed, sedated Children. Anesthesiology 2003;98:41-45.

11. Dalal PG, Murray D, Messner AH, Feng A, Mcallister J, Molter D. Pediatric laryngeal dimensions: an age-based analysis. Anesth Analg 2009;108:1475-1479.

12. Wani TM, Rafiq M, Nahida A, AlGhamdi FS, Tobias J. Upper airway in infants - a computed tomography-based analysis. Pediatr Anesth 2017;27:501-505.

13. Nemeth J, Maghraby N, Kazim S. Emergency Airway Management: the Difficult Airway. Emerg Med Clin North Am 2012; 30:401-420.

14. Santos AP, Mathias LA, Gozzani JL, Watanabe M. Difficult intubation in children: applicability of the Mallampati index. Rev Bras Anestesiol 2011;61:159-162.

15. Klucka J, Stourac P, Stoudek R, Toukalkova M, Harazim H, Kosinova M. Controversies in pediatric perioperative airways. Biomed Res Int 2015;2015:1-11.

16. Echeverry Marín PC, Engelhardt T. Algoritmo para el manejo de la vía aérea difícil en pediatría. Rev Colomb Anestesiol 2014;42: 325-334.

17. Engelhardt T, Weiss M. A child with a difficult airway: what do I do next? Curr Opin Anaesthesiol 2012;25:326-332.

18. Moyao D. La vía aérea en pediatría. Rev Mex Anestesiol 2016;39: 5-7.

19. Ireland Association of Paediatric Anaesthetists of Great Britain and. Difficult mask ventilation (MV) - during routine induction of anaesthesia in a child aged 1 to 8 years [Internet]. Association of Paediatric Anaesthetists of Great Britain and Ireland. 2012 [cited 2017 Mar 2]. Available from:

20. Black AE, Flynn PER, Smith HL, Thomas ML, Wilkinson KA. Development of a guideline for the management of the unanticipated difficult airway in pediatric practice. Paediatr Anaesth 2015;25:346-362.

21. Echeverry Marín PC, Arenas Correa ID, Gonzalez Valencia NJ. Jaramillo Mejia J, Echeverry Marín PC, Gómez Menendez JM. Cuidado de la vía aérea. Tratado de Anestesia Pediátrica 1st ed Sociedad Colombiana de Anestesiología y Reanimación S.C.A.R.E, Bogotá Colombia:2015;583-617.

22. Fiadjoe JE, Kovatsis P. Videolaryngoscopes in pediatric anesthesia: what’s new? Minerva Anestesiol 2014;80:76-82.

23. Green-Hopkins I, Eisenberg M, Nagler J. Video Laryngoscopy in the Pediatric Emergency Department: Advantages and Approaches. Clin Pediatr Emerg Med 2015;16:195-202.

24. Lingappan K, Arnold JL, Shaw TL, Fernandes CJ, Pammi M. Videolaryngoscopy versus direct laryngoscopy for tracheal intubation in neonates. Cochrane database Syst Rev 2015;18: CD009975.

25. Huang A, Jagannathan N. The Role of Supraglottic Airways in Pediatric Emergency Medicine. Clin Pediatr Emerg Med Elsevier Inc 2015;16:162-171.

26. Stacey J, Heard AMB, Chapman G, Wallace CJ, Hegarty M, Vijayasekaran S, et al. The “Can”t Intubate Can’t Oxygenate’ scenario in Pediatric Anesthesia: a comparison of different devices for needle cricothyroidotomy. Pediatr Anesth 2012;22: 1155-1158.

27. Jagannathan N, Sohn L, Fiadjoe JE. Paediatric difficult airway management: What every anaesthetist should know!. Br J Anaesth 2016;117 (Suppl 1):i3-i5.

28. Lee JH, Smith PB, Quek MBH, Laughon MM, Clark RH, Hornik CP. Risk factors and in-hospital outcomes following tracheostomy in infants. J Pediatr 2016;173:39-44.

29. Emerson B, Shepherd M, Auerbach M. Technology-Enhanced Simulation Training for Pediatric Intubation. Clin Pediatr Emerg Med 2015;16:203-212.
How to Cite
Rivera-Tocancipá D, Díaz-Sánchez E. Pediatric airway: as difficult as they say?. Colomb. J. Anesthesiol. [Internet]. 2018Dec.1 [cited 2021Dec.5];46(Supplement):52-7. Available from:


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How to Cite
Rivera-Tocancipá D, Díaz-Sánchez E. Pediatric airway: as difficult as they say?. Colomb. J. Anesthesiol. [Internet]. 2018Dec.1 [cited 2021Dec.5];46(Supplement):52-7. Available from:

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