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Updated: Aug 17, 2026
A Novel Rescue Technique for Difficult Intubation and Difficult Ventilation
Published on: January 17, 2011
[The management of the difficult pediatric airway]
Tetsuro Isada1, Takaaki Miwa, Koichi Hiroki
1Department of Anesthesiology and Reanimatology, Faculty of Medicine, University of Fukui, Fukui 910-1104.
Insights
The incidence of difficult pediatric airway varies significantly among congenital syndromes. This retrospective study analyzed 13,557 pediatric patients, finding that syndromes like Treacher Collins have a higher rate of difficult tracheal intubation.
Area of Science:
- Pediatric Anesthesiology
- Airway Management
- Congenital Abnormalities
Context:
- Managing difficult pediatric airways due to congenital abnormalities presents challenges.
- No prior systematic examination existed for difficult pediatric airway management.
Purpose:
- To retrospectively examine the incidence of difficult airway in pediatric patients undergoing general anesthesia with tracheal intubation.
- To classify and analyze the severity of intubation difficulties.
Summary:
- A retrospective analysis of 13,557 pediatric patients revealed a 0.17% incidence of difficult airway (grades 3 and 4).
- Difficulties were significantly different across various congenital syndromes (P<0.001).
- Syndromes such as Treacher Collins and arthrogryposis multiplex congenita showed higher incidence, while Pierre-Robin and Crouzon syndromes had lower rates.
Impact:
- Highlights the variable incidence of difficult pediatric airways across different congenital syndromes.
- Provides crucial data for anesthesiologists managing pediatric patients with congenital abnormalities.
- Informs risk assessment and airway management strategies for specific pediatric syndromes.
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 1 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.
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