The management of the difficult pediatric airway

BACKGROUND: We are faced sometimes with the difficult pediatric airway due to congenital abnormalities. However, there has been no systematic examination for the management of the difficult pediatric airway. METHODS: We retrospectively examined the incidence of difficult airway in 13,557 pediatric patients who had undergone general anesthesia with tracheal intubation. The difficulties of the intubation were classified into grade 1 to 4; grade 1: intubated one time, grade 2: two times, grade 3: three times or more, grade 4: changed to another way. We defined grade 3 and 4 as "difficult airway". RESULTS: Twenty-five patients (0.17%) are "difficult airway" among 13,557 patients in which 21 patients (0.15%) are classified as grade 3, and 4 patients (0.02%) are grade 4. The difficulties were significantly different among the syndromes (P< 0.001). The rate of the incidence in the difficulty is high in Treacher Collins syndrome, arthrogryposis multiprex congenita and first and second brachial arch syndrome, but few is in Pierre-Robin syndrome, Crouzon syndrome and Apert syndrome which are known to accompany difficult airway. CONCLUSIONS: We demonstrated that the incidence of difficult airway is different among the syndromes.