The management of the difficult pediatric airway
Isada, T.; Miwa, T.; Hiroki, K.; Fukuda, S.
Masui. Japanese Journal of Anesthesiology 54(5): 490-495
2005
ISSN/ISBN: 0021-4892 PMID: 15915746 Document Number: 592598
Background:We are faced sometimes with the difficult pediatric airway due to congenital abnormalities. However, there has been no systematic examination for the management of the difficult pediatric airway.Methods: We retrospectively examined the incidence of difficult airway in 13,557 pediatric patients who had undergone general anesthesia with tracheal intubation. The difficulties of the intubation were classified into grade I to 4; grade 1 : intubated one time, grade 2: two times, grade 3: three times or more, grade 4: changed to another way. We defined grade 3 and 4 as "difficult airway".Results: Twenty-five patients (0.17%) are "difficult airway" among 13,557 patients in which 21 patients (0.15%) are classified as grade 3, and 4 patients (0.02%) are grade 4. The difficulties were significantly different among the syndromes (P<0.001). The rate of the incidence in the difficulty is high in Treacher-Collins syndrome, arthrogryposis multiprex congenita and first and second brachial arch syndrome, but few is in Pierre-Robin syndrome, Crouzon syndrome and Apert syndrome which are known to accompany difficult airway.Conclusions: We demonstrated that the incidence of difficult airway is different among the syndromes.