ABSTRACT
Difficult airway management in children may be defined as any condition in which holding a mask airway is awkward or in which bag-and-mask ventilation is hard to achieve with conventional equipment. Difficult intubation may be defined as tracheal intubation requiring more than three attempts, or abnormalities demanding advanced airway techniques. Fortunately, most children who present such
difficulties can be identified preoperatively, because they have either a syndrome associated with airway abnormalities or a suggestive diagnosis (Table 21.1). In adults, the incidence of difficult direct laryngoscopy is 1.5-8.5 per cent, and failed intubations occur in 0.13-0.3 per cent [1]; equivalent figures for children are unknown but are believed to be considerably lower [2]. Difficult intubation in paediatric cardiac patients has been reported to be 1.25 per cent, with 50 per cent of these having syndromal abnormalities
Introduction 315 Causes of difficult paediatric intubation 316 Identification of the child with a difficult airway 316 Management of the difficult airway 318 Techniques for airway management 321 Techniques for the management of difficult
tracheal intubation 322 Bullard laryngoscope 324 Light wand 325 Lighted tube stylet 325
Rigid bronchoscopy 325 Submental intubation 325 Retrograde intubation 325 The difficult airway after surgery 326 Failed intubation 326 Complications associated with difficult airway
management 327 Equipment 327 Training and maintaining airway skills 327 References 328
[3]. The overall incidence of difficult intubation in children with cleft lip or palate is 4.7 per cent, most frequently in infants aged 1-6 months (7 per cent) [4].
