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Updated: Mar 31, 2026

A Novel Rescue Technique for Difficult Intubation and Difficult Ventilation
Published on: January 17, 2011
Evidence-Based Emergency Management Of The Pediatric Airway
Amandeep Singh1, Oron Frenkel2
1Alameda County Medical Center, Highland Hospital, Oakland, CA; Assistant Clinical Professor of Emergency Medicine, University of California San Francisco, San Francisco, CA.
Insights
This review examines recent advancements in pediatric rapid sequence intubation (RSI), focusing on preoxygenation, complication prevention, and agent selection for emergency airway management in children.
Area of Science:
- Pediatric Emergency Medicine
- Anesthesiology
- Critical Care
Background:
- Pediatric airway emergencies are infrequent but stressful events in emergency settings.
- Recent literature introduces novel concepts for rapid sequence intubation (RSI) in children.
Purpose of the Study:
- To analyze current evidence on pediatric RSI.
- To provide a structured approach to pediatric airway management.
- To highlight best practices for intubation-related complications.
Main Methods:
- Systematic review of recent clinical trials and review articles on pediatric RSI.
- Analysis of pediatric anatomic and physiologic differences relevant to intubation.
- Evaluation of assessment tools like the pediatric assessment triangle.
Main Results:
- Novel concepts in preoxygenation, complication prevention, and agent selection for pediatric RSI.
- Detailed review of the pediatric assessment triangle and a systematic approach to pediatric RSI.
- Discussion of alternative airway devices and special considerations for obese and difficult airways.
Conclusions:
- Evidence-based recommendations for pediatric rapid sequence intubation.
- Improved understanding of pediatric airway physiology and assessment.
- Guidance for managing complex pediatric airway emergencies.
Abstract:
Pediatric airway emergencies are rare, yet they are anxiety-provoking events that can occur in both pediatric and general emergency departments. Several novel concepts regarding preoxygenation during rapid sequence intubation, anticipation and prevention of intubation-related complications, the utility of premedication agents, and the selection of induction and paralytic agents have been highlighted in recent clinical trials and review articles. In this review, we analyze the data behind these concepts, highlight current pediatric literature related to these issues, and present reasonable conclusions based on the best available evidence. We begin with an analysis of the anatomic and physiologic differences commonly encountered in the pediatric patient during rapid sequence intubation, and we then review a systematic approach to the assessment of the pediatric patient in respiratory distress (ie, the pediatric assessment triangle) and conclude with a simple approach to pediatric rapid sequence intubation, starting with the preparatory phase and ending with postintubation management. We additionally highlight several alternative airway devices and discuss special situations, including rapid sequence intubation in the obese pediatric patient and in the difficult airway patient.
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