Guideline update: Neonatal and infant airway management

Managing the neonatal and infant airway is challenging due to several anatomic and physiologic differences compared to adults. In 2024, the European Society of Anaesthesiology and Intensive Care and British Journal of Anaesthesia published joint guidelines on airway management in neonates and infants (defined as <1 year). The guidelines recommend using history and physical examination to predict a difficult airway. They recommend using sedatives such as etomidate or ketamine to ensure appropriate anaesthesia combined with neuromuscular blocking agents. Videolaryngoscopy is the first choice for intubation, and apneic oxygenation should be used during the intubation attempt. A supraglottic device can be used for rescue oxygenation and ventilation if tracheal intubation is unsuccessful. The number of attempts should be limited, with consideration of changing to a different technique, provider, or both after each unsuccessful attempt. A stylet should be used for hyperangulated videolaryngoscopy blades and airways that are anatomically anterior. End-tidal capnography should be used to verify intubation. The guidelines also incorporate considering human factors to improve patient care and reduce harm. This review summarizes the 2024 guideline recommendations for management of the neonatal and infant airway with an emphasis on their impact on emergency medicine.