Difficult Airway Management in Neonates and Infants: Knowledge of Devices and a Device-Oriented Strategy.

Teiji Sawa,Koichi Akiyama,Atsushi Kainuma,Mao Kinoshita,Masayuki Shibasaki

doi:10.3389/fped.2021.654291

Abstract

Difficult airway management (DAM) in neonates and infants requires anesthesiologists and critical care clinicians to respond rapidly with appropriate evaluation of specific situations. Therefore, organizing information regarding DAM devices and device-oriented guidance for neonate and infant DAM treatment will help practitioners select the safest and most effective strategy. Based on DAM device information and reported literature, there are three modern options for DAM in neonates and infants that can be selected according to the anatomical difficulty and device-oriented strategy: (1) video laryngoscope (VLS), (2) supraglottic airway device (SAD), and (3) flexible fiberoptic scope (FOS). Some VLSs are equipped with small blades for infants. Advanced SADs have small sizes for infants, and some effectively function as conduits for endotracheal intubation. The smallest FOS has an outer diameter of 2.2 mm and enables intubation with endotracheal tubes with an inner diameter of 3.0 mm. DAM in neonates and infants can be improved by effectively selecting the appropriate device combination and ensuring that available providers have the necessary skills.

Highlights

Difficult airway management (DAM) in neonates and infants requires anesthesiologists and critical care clinicians to respond rapidly because of these patients’ unique physiological characteristics
Three sets of pediatric difficult airway guidelines (APA1–APA3) were released by the Association of Pediatric Anesthetists of Great Britain and Ireland in 2015 [1,2,3]: APA1 is for difficult mask ventilation during routine anesthesia, APA2 is for unanticipated difficulty in tracheal intubation during routine anesthesia induction, and APA3 is for inability to intubate and ventilate paralyzed anesthetized patients
Information regarding DAM devices, and our recent experience, this review summarizes the characteristics of available DAM devices for newborns and infants and discusses strategies for DAM in these patients

Summary

Introduction

Difficult airway management (DAM) in neonates and infants requires anesthesiologists and critical care clinicians to respond rapidly because of these patients’ unique physiological characteristics. The first type is equipped with an optical system in the blade with a viewing window in the body and includes the C-MAC R VLS, GlideScope R , Multiview Scope R , and Truview PCDTM Pediatric.

Results

Conclusion