title: A child with a difficult airway:  what do I do next?
abstract: OBJECTIVE
  Difficulties in pediatric airway management are common and continue to result in significant morbidity and mortality. This review reports on current concepts in approaching a child with a difficult airway.
  
  
  RESULTS
  Routine airway management in healthy children with normal airways is simple in experienced hands. Mask ventilation (oxygenation) is always possible and tracheal intubation normally simple. However, transient hypoxia is common in these children usually due to unexpected anatomical and functional airway problems or failure to ventilate during rapid sequence induction. Anatomical airway problems (upper airway collapse and adenoid hypertrophy) and functional airway problems (laryngospasm, bronchospasm, insufficient depth of anesthesia and muscle rigidity, gastric hyperinflation, and alveolar collapse) require urgent recognition and treatment algorithms due to insufficient oxygen reserves. Early muscle paralysis and epinephrine administration aids resolution of these functional airway obstructions. Children with an 'impaired' normal (foreign body, allergy, and inflammation) or an expected difficult (scars, tumors, and congenital) airway require careful planning and expertise. Training in the recognition and management of these different situations as well as a suitably equipped anesthesia workstation and trained personnel are essential.
  
  
  CONCLUSIONS
  The healthy child with an unexpected airway problem requires clear strategies. The 'impaired' normal pediatric airway may be handled by anesthetists experienced with children, whereas the expected difficult pediatric airway requires dedicated pediatric anesthesia specialist care and should only be managed in specialized centers.
authors.affiliation: Department of Anaesthesia, Royal Aberdeen Children's Hospital, Aberdeen, Scotland, UK. t.engelhardt@nhs.net
authors.forename: Thomas
authors.initials: T
authors.lastname: Engelhardt
authors.forename: Markus
authors.initials: M
authors.lastname: Weiss
mesh_terms: D058109:Airway Management / Q000145:classification / Q000295:instrumentation / Q000379:methods*; D000402:Airway Obstruction / Q000150:complications; D000758:Anesthesia / Q000379:methods; D002648:Child; D006801:Humans; D007442:Intubation, Intratracheal / Q000145:classification / Q000379:methods*; D017214:Laryngeal Masks; D012121:Respiration, Artificial / Q000009:adverse effects; D012140:Respiratory Tract Diseases / Q000453:epidemiology