[Management of difficult pediatric airway]

Anesthesiologists should be familiar with the management of airway and be able to recognize and identify potential difficult airway. These entities include congenital craniofacial deformities with micrognathia (e.g. Robin sequence, Treacher Collins, Goldenhar's, Crouzon's syndromes) and metabolic diseases causing the deposit of accumulated by-products (e.g., Hurler's, Morquio's, Beckwith-Wiedemann syndromes). Cormack and Lehane grades 3 and 4 at laryngoscopy are an indication for advanced techniques for intubation. The laryngeal mask airway (LMA) and fiberscope with a directable tip are useful and important modalities in handling difficult pediatric airway and intubation. LMA not only offers another mode of securing airway besides face mask and tracheal intubation, but also provides a conduit for tracheal intubation and a rescue airway in the CICV (cannot intubate, cannot ventilate) situations. Intubation with a fiberscope can be utilized through LMA or through a specially designed face mask. Face mask designed for fiberoptic intubation has a 15 mm port for connection with the breathing circuit and another 22 mm port covered with a rubber membrane through which the fiberscope is introduced and directed to the larynx and trachea followed by the tracheal tube while ventilating and anesthetizing the pediatric patients with inhalational anesthetics. Getting used to these two modalities, LMA and fiberoptic intubation of the trachea, gives a great advantage in handling of difficult pediatric airway and intubation.