Assessment and management of the predicted difficult airway in babies and children

It is essential that all anaesthetists have a strategy for managing the predicted difficult paediatric airway. The majority of children who have difficult airways are identifiable preoperatively. The situation where a child is unexpectedly difficult to bag-and-mask ventilate, intubate, or both is rare. Therefore anaesthetists usually have adequate time for thought and preparation with regard to ultimately securing the airway.Inadequate airway assessment can contribute to poor airway outcomes. This article outlines the anatomical and physiological differences present in the child and describes clinical assessment of the paediatric airway. Equipment available for managing the predicted difficult airway in a child is also reviewed. Video laryngoscopy, for example, has become more popular in recent years and may increasingly be incorporated into difficult airway algorithms of the future.Emphasis is placed on planning, preparation and practice: the three Ps of the difficult paediatric airway.