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Canadian pediatric anesthesiologists prefer inhalational anesthesia to manage difficult airways: a survey

[Les anesthésiologistes pédiatriques canadiens préfèrent l’anesthésie par inhalation dans les cas de problèmes des voies aériennes : une enquête]

From the Department of Anesthesiology, British Columbia’s Children’s Hospital and University of British Columbia, Vancouver, British Columbia, Canada.

Address correspondence to:: Dr. J. Mark Ansermino, Department of Anesthesiology, University of British Columbia, British Columbia’s Children’s Hospital, 4480 Oak Street, Room 1L7, Vancouver, British Columbia V6H 3V4, Canada. Phone: 604-875-2345; E-mail: anserminos{at}yahoo.ca

Purpose: To survey Canadian pediatric anesthesiologists to assess practice patterns in managing pediatric patients with difficult airways.

Methods: Canadian pediatric anesthesiologists were invited to complete a web survey. Respondents selected their preferred anesthetic and airway management techniques in six clinical scenarios. The clinical scenarios involved airway management for cases where the difficulty was in visualizing the airway, sharing the airway and accessing a compromised airway.

Results: General inhalational anesthesia with spontaneous respiration was the preferred technique for managing difficult intubation especially in infants (90%) and younger children (97%), however, iv anesthesia was chosen for the management of the shared airway in the older child (51%) where there was little concern regarding difficulty of intubation. Most respondents would initially attempt direct laryngoscopy for the two scenarios of anticipated difficult airway (73% and 98%). The laryngeal mask airway is commonly used to guide fibreoptic endoscopy. The potential for complete airway obstruction would encourage respondents to employ a rigid bronchoscope as an alternate technique (17% and 44%).

Conclusion: Inhalational anesthesia remains the preferred technique for management of the difficult pediatric airway amongst Canadian pediatric anesthesiologists. Intravenous techniques are relatively more commonly chosen in cases where there is a shared airway but little concern regarding difficulty of intubation. In cases of anticipated difficult intubation, direct laryngoscopy remains the technique of choice and fibreoptic laryngoscopy makes a good alternate technique. The use of the laryngeal mask airway was preferred to facilitate fibreoptic intubation.

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