title: Development of a guideline for the management of the unanticipated difficult airway in pediatric practice.
abstract: BACKGROUND
  Most airway problems in children are identified in advance; however, unanticipated difficulties can arise and may result in serious complications. Training for these sporadic events can be difficult. We identified the need for a structured guideline to improve clinical decision making in the acute situation and also to provide a guide for teaching.
  
  
  OBJECTIVE
  Guidelines for airway management in adults are widely used; however, none have been previously devised for national use in children. We aimed to develop guidelines for the management of the unanticipated difficult pediatric airway for use by anesthetists working in the nonspecialist pediatric setting.
  
  
  METHODS
  We reviewed available guidelines used in individual hospitals. We also reviewed research into airway management in children and graded papers for the level of evidence according to agreed criteria. A Delphi panel comprising 27 independent consultant anesthetists considered the steps of the acute airway management guidelines to reach consensus on the best interventions to use and the order in which to use them. If following the literature review and Delphi feedback, there was insufficient evidence or lack of consensus, regarding inclusion of a particular point; this was reviewed by a Second Specialist Group comprising 10 pediatric anesthetists.
  
  
  RESULTS
  Using the Delphi group's deliberations and feedback from the Second Specialist Group, we developed three guidelines for the acute airway management of children aged 1-8 years.
  
  
  CONCLUSIONS
  This paper provides the background, available evidence base, and justification for each step in the resultant guidelines and gives a rationale for their use.
authors: Department of Anaesthesia, Great Ormond Street Hospital for Children, London, UK.
authors: Ann E
authors: AE
authors: Black
authors: Paul E R
authors: PE
authors: Flynn
authors: Helen L
authors: HL
authors: Smith
authors: Mark L
authors: ML
authors: Thomas
authors: Kathy A
authors: KA
authors: Wilkinson
mesh_terms: D000293:Adolescent; D058109:Airway Management / Q000295:instrumentation / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D032921:Consensus; D003697:Delphi Technique; D006801:Humans; D007223:Infant; D007431:Intraoperative Complications / Q000628:therapy*; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000379:methods; D017214:Laryngeal Masks / Q000009:adverse effects; D010100:Oxygen / Q000097:blood; D056888:Patient Positioning; D013272:Stomach Diseases / Q000209:etiology; D014139:Tracheostomy
chemical_list: D010100:Oxygen
keywords: cricothyroidotomy; intratracheal; intubation; pediatric anesthesia; practice guidelines; supraglottic airway