Paediatric anaesthesia and airway management is in many ways similar to adult practice; however, deep understanding of the differences in anatomy, physiology and behavioural psychology is necessary, particularly in younger children and infants. This chapter aims to provide the anaesthetist with information on these differences and (re)introduce techniques and practical tips that may help practitioners with airway management in this population. The broad range of equipment sizes and drug doses are a challenge to memorise and guides are highly advised. While difficult airways are less frequent in children, their management can be challenging. Upper airway obstruction is a particularly frequent occurrence, and should be anticipated and prevented, focussing on basic, and much underappreciated, skills such as positioning, effective bag-mask ventilation and occasional careful use of adjuncts. Safe and non-traumatic practice is key. It is important to stress that modern devices such as videolaryngoscopes should be used carefully and under visual guidance at all times. Awake flexible optical bronchoscope (FOB)-guided intubation is the gold standard in adult difficult airway management. In paediatric practice, however, advanced airway procedures may need to be performed with prior general anaesthesia. We offer an introduction to some advanced techniques including paediatric emergency front of neck airway.

Expertise in airway management in infants and young children requires a comprehensive knowledge and understanding of the developmental anatomy of the human upper airway from birth through adolescence. This chapter will review these topics as well as the anatomical and developmental causes for common syndromes that are associated with difficult mask ventilation or difficult tracheal intubation.

The technique of laryngoscopy is essential in the daily delivery of many anesthetics. Direct and indirect methods of laryngoscopy are quite commonly utilized. This chapter will address considerations as they relate to direct laryngoscopy.

SGA devices have been used successfully in patients of all ages in various clinical scenarios, including primary airway management under general anesthesia in the operating room, and resuscitation and emergent airway management in the emergency department (ED) and prehospital settings. SGA devices have been used as alternatives to face-mask ventilation and tracheal intubation by healthcare providers with proficient airway management skills, but also by those with less experience, to successfully oxygenate and ventilate the lungs. The clinical efficacy of SGA devices in children has been proven in a large number of clinical studies. Pediatric SGA devices have undergone an evolution in design since their introduction 30 years ago. These newer design features have improved the use of SGA devices to provide positive-pressure ventilation and facilitate fiberoptic-guided tracheal intubation. The evolution, versatility, and utility of the SGA device will be discussed in detail in this chapter.

There are some unique considerations when caring for the airway in infants and small children. They have relatively larger oropharyngeal structures (tongue, tonsils, and adenoids), and a large and floppy epiglottis, which can predispose to upper airway obstruction. A larger occiput may increase the neck flexion observed while in supine position as compared with adults, which can also lead to airway obstruction. The shorter and narrower trachea may increase the risk for tracheal tube malposition after intubation, and has a greater risk for secretions, edema, or foreign body to produce disproportionate negative effects in airflow resistance. Children run the highest risk of problems from stridor and glottic edema because of their smaller diameter airways. Post-extubation stridor incidence ranges from 2% in children having elective surgical procedures to 40% in pediatric trauma and burn victims. Additionally, infants have less physical space in the oropharynx and within the tracheal tube for an advanced bridging technique such as SGA devices and/or airway exchange catheter.

There are some unique considerations when caring for the airway in infants and small children. They have relatively larger oropharyngeal structures (tongue, tonsils, and adenoids), and a large and floppy epiglottis, which can predispose to upper airway obstruction. A larger occiput may increase the neck flexion observed while in supine position as compared with adults, which can also lead to airway obstruction. The shorter and narrower trachea may increase the risk for tracheal tube malposition after intubation, and has a greater risk for secretions, edema, or foreign body to produce disproportionate negative effects in airflow resistance. Children run the highest risk of problems from stridor and glottic edema because of their smaller diameter airways. Post-extubation stridor incidence ranges from 2% in children having elective surgical procedures to 40% in pediatric trauma and burn victims. Additionally, infants have less physical space in the oropharynx and within the tracheal tube for an advanced bridging technique such as SGA devices and/or airway exchange catheter.