title: Canadian pediatric anesthesiologists prefer inhalational anesthesia to manage difficult airways.
abstract: OBJECTIVE
  To survey Canadian pediatric anesthesiologists to assess practice patterns in managing pediatric patients with difficult airways.
  
  
  METHODS
  Canadian pediatric anesthesiologists were invited to complete a web survey. Respondents selected their preferred anesthetic and airway management techniques in six clinical scenarios. The clinical scenarios involved airway management for cases where the difficulty was in visualizing the airway, sharing the airway and accessing a compromised airway.
  
  
  RESULTS
  General inhalational anesthesia with spontaneous respiration was the preferred technique for managing difficult intubation especially in infants (90%) and younger children (97%), however, iv anesthesia was chosen for the management of the shared airway in the older child (51%) where there was little concern regarding difficulty of intubation. Most respondents would initially attempt direct laryngoscopy for the two scenarios of anticipated difficult airway (73% and 98%). The laryngeal mask airway is commonly used to guide fibreoptic endoscopy. The potential for complete airway obstruction would encourage respondents to employ a rigid bronchoscope as an alternate technique (17% and 44%).
  
  
  CONCLUSIONS
  Inhalational anesthesia remains the preferred technique for management of the difficult pediatric airway amongst Canadian pediatric anesthesiologists. Intravenous techniques are relatively more commonly chosen in cases where there is a shared airway but little concern regarding difficulty of intubation. In cases of anticipated difficult intubation, direct laryngoscopy remains the technique of choice and fibreoptic laryngoscopy makes a good alternate technique. The use of the laryngeal mask airway was preferred to facilitate fibreoptic intubation.
authors.affiliation: Department of Anesthesiology, University of British Columbia, British Columbia's Children's Hospital, 4480 Oak Street, Vancouver, British Columbia V6H 3V4, Canada.
authors.forename: Peter
authors.initials: P
authors.lastname: Brooks
authors.forename: Ron
authors.initials: R
authors.lastname: Ree
authors.forename: David
authors.initials: D
authors.lastname: Rosen
authors.forename: Mark
authors.initials: M
authors.lastname: Ansermino
mesh_terms: D000769:Anesthesia, Inhalation; D000776:Anesthesiology / Q000379:methods*; D001999:Bronchoscopy; D002648:Child; D002675:Child, Preschool; D005336:Fiber Optic Technology; D006801:Humans; D007223:Infant; D007442:Intubation, Intratracheal / Q000379:methods*