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  • Print publication year: 2010
  • Online publication date: January 2011

Chapter 21 - The paediatric airway

from Section 3 - Specialties


Understanding the equipment, knowledge of airway anatomy, good endoscopy skills, correct choice of tubes and railroading techniques are vital to the success of flexible fibreoptic intubation techniques. The modern day flexible fibreoptic scope consists of the following parts: body, insertion cord, light source, and camera and monitor. There are three ways in which an endoscopist can manipulate the tip of the fibrescope towards the desired target. These are advancement, tip deflection and rotation. Fibreoptic endoscopy involves guiding the tip of the fibrescope from the nose or the mouth into the trachea under continuous vision. The final stage of fibreoptic intubation involves railroading the tracheal tube and removing the fibrescope from the tube. Flexible fibreoptic intubation has revolutionised the management of patients with known anatomical airway difficulties. The practical fibreoptic techniques include awake fibreoptic intubation, asleep fibreoptic intubation, and retrograde fibreoptic intubation.

Further reading

BinghamR, PatelP. (2009). Laryngeal mask airway & other supraglottic airway devices in paediatric practice. Continuing Education in Anaesthesia, Critical Care & Pain, 9(1).
BlackA. (2008). Management of the difficult airway. In: BinghamR, Lloyd-ThomasAR, SuryMRJ (Eds.), Hatch & Sumner's Textbook of Paediatric Anaesthesia. 3rd ed. London: Hodder Arnold. pp. 315–331.
BorlandLM, SereikaSM, WoelfelSK, et al. (1998). Pulmonary aspiration in pediatric patients during general anesthesia: incidence and outcome. Journal of Clinical Anaesthesia, 10, 95–102.
BradyM, KinnS, O'RourkeK, et al. (2005). Preoperarive fasting for preventing perioperative complications in children. Cochrane Database Systematic Reviews, 2, CD005285.
BrooksP, ReeR, RosenD, AnserimoM. (2005). Canadian pediatric anesthesiologists prefer inhalational anesthesia to manage difficult airways. Canadian Journal of Anesthesia 52, 285–290.
CaldwellM, WalkerRWM. (2003). Management of the difficult paediatric airway. British Journal of Anaesthesia, CEPD Review, 3, 167–169.
FadenH. (2006). The dramatic change in the epidemiology of pediatric epiglottitis. Pediatric Emergency Care, 22, 443–444.
JamesI. (2001). Cuffed tubes in children. Editorial. Paediatric Anaesthesia, 11, 259–263.
JenkinsIA, SaundersM. (2009). Infections of the airway. Paediatric Anaesthesia, 19(Suppl 1), 118–130.
KatzJ, StewardDJ. (1993). Anesthesia and Uncommon Pediatric Diseases. 2nd ed. Philadelphia: WB Saunders.
LangSA, DuncanPG, ShephardDA, HaHC. (1990). Pulmonary oedema associated with airway obstruction. Canadian Journal of Anaesthesia, 37, 210–218.
MarcusRJ, ThompsonJP. (2000). Anaesthesia for manipulation of forearm fractures in children: A survey of current practice. Pediatric Anesthesia, 10, 273–277.
RobertsS, ThorningtonR. (2005). Paediatric bronchoscopy. Continuing Education in Anaesthesia, Critical Care & Pain, 5, 41–44.
SeidelJ, DormanT. (2006). Anesthetic management of preschool children with penetrating eye injuries: postal survey of pediatric anesthetists and review of the available evidence. Pediatric Anesthesia, 16, 769–776.
StewardD, LermanJ. (2001). Manual of Pediatric Anaesthesia. 5th ed. New York: Churchill Livingstone.
StoddartPA, BrennanL, HatchDJ, BinghamR. (1994). Postal survey of paediatric practice and training among consultant anaesthetists in the UK. British Journal of Anaesthesia, 73, 559–563.
TiretL, NivocheY, HattonF, et al. (1988). Complications related to anaesthesia in infants and children. A prospective survey of 40240 anaesthetics. British Journal of Anaesthesia, 61, 263–269.
WalkerR. (2000). The Laryngeal Mask Airway in the difficult airway: An assessment of positioning and use in fibreoptic intubation. Paediatric Anaesthesia, 10, 53–58.
WarnerMA, WarnerME, WarnerDO, et al. (1999). Perioperative pulmonary aspiration in infants and young children. Anesthesiology, 90, 66–71.
WeissM, DullenkopfA, FischerJE, KellerC, GerberAC. (2009). Prospective randomized controlled multi-centre trial of cuffed endotracheal tubes in small children. British Journal of Anaesthesia, 103, 867–873.
WeissM, SchwartzU, DillierCM, GerberAC. (2001). Teaching and supervising tracheal intubation in paediatric patients using videolaryngoscopy. Paediatric Anaesthesia, 11, 343–348.