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Updated: Aug 2, 2025
A Novel Rescue Technique for Difficult Intubation and Difficult Ventilation
Published on: January 17, 2011
Difficult or impossible facemask ventilation in children with difficult tracheal intubation: a retrospective analysis
Annery G Garcia-Marcinkiewicz1, Lisa K Lee2, Bishr Haydar3
1Department of Anesthesiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Insights
Difficult facemask ventilation in children is linked to specific physical traits and anesthetic choices. Early identification of these factors can improve patient outcomes and airway management strategies.
Area of Science:
- Pediatric Anesthesiology
- Airway Management
- Critical Care Medicine
Background:
- Difficult facemask ventilation poses significant risks in pediatric patients, especially those with challenging tracheal intubation.
- Identifying predictive factors for difficult mask ventilation is crucial for patient safety during anesthesia.
Purpose of the Study:
- To investigate physical characteristics and anesthetic factors associated with difficult mask ventilation in pediatric patients.
- To assess the incidence of complications and the efficacy of rescue airway devices in cases of difficult mask ventilation.
Main Methods:
- A multicenter registry was queried for pediatric cases of difficult or impossible facemask ventilation.
- Regularized multivariable regression analysis was used to identify predictive factors.
- Complication rates and supraglottic airway device efficacy were tabulated.
Main Results:
- The incidence of difficult mask ventilation was 9% (483/5453).
- Infants, those with low weight-for-age percentile, Treacher-Collins syndrome, glossoptosis, or limited mouth opening were at higher risk.
- Anesthetic induction with facemask and opioids reduced the risk; rescue supraglottic airway improved ventilation in 71% of cases.
Conclusions:
- Specific physical findings should raise suspicion for difficult mask ventilation in children.
- Prompt consideration of rescue supraglottic airway devices is recommended for difficult or impossible mask ventilation scenarios.
Background:
Difficult facemask ventilation is perilous in children whose tracheas are difficult to intubate. We hypothesised that certain physical characteristics and anaesthetic factors are associated with difficult mask ventilation in paediatric patients who also had difficult tracheal intubation.
Methods:
We queried a multicentre registry for children who experienced "difficult" or "impossible" facemask ventilation. Patient and case factors known before mask ventilation attempt were included for consideration in this regularised multivariable regression analysis. Incidence of complications, and frequency and efficacy of rescue placement of a supraglottic airway device were also tabulated. Changes in quality of mask ventilation after injection of a neuromuscular blocking agent were assessed.
Results:
The incidence of difficult mask ventilation was 9% (483 of 5453 patients). Infants and patients having increased weight, being less than 5th percentile in weight for age, or having Treacher-Collins syndrome, glossoptosis, or limited mouth opening were more likely to have difficult mask ventilation. Anaesthetic induction using facemask and opioids was associated with decreased risk of difficult mask ventilation. The incidence of complications was significantly higher in patients with "difficult" mask ventilation than in patients without. Rescue placement of a supraglottic airway improved ventilation in 71% (96 of 135) of cases. Administration of neuromuscular blocking agents was more frequently associated with improvement or no change in quality of ventilation than with worsening.
Conclusions:
Certain abnormalities on physical examination should increase suspicion of possible difficult facemask ventilation. Rescue use of a supraglottic airway device in children with difficult or impossible mask ventilation should be strongly considered.
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