Pediatric Airway Management: Steps Through the Time

Perioperative morbidity and mortality are still high among pediatric patients undergoing anesthesia. The incidence of perioperative critical events is 5,2% [1]. Out of which, respiratory complications related to the airway management are one of the main causes with the incidence of 3,1% [1]. Firstly, laryngospasm and bronchospasm, prolonged unsuccessful intubation, all of that is leading to hypoxia, and hypoxia to cardiac arrest, major disability, neurologic deficit or death. Other main causes for high incidence of perioperative morbidity and mortality undergoing anesthesia are cardiac (hypotension and bradycardia), allergic and neurological complications [1]. These complications are not dependant on the type of anasthesia, as the major risk factor is actually age [1]. APRICOT study revealed evidence supporting the beneficial effect of years of experience of the most senior anaesthesia team member for respiratory and cardiac critical events, rather than the type of health institution or providers [1]. In addition, NECTARINE study showed that perioperative complications in infants associated with increased risk of morbidity and mortality are mainly hypotension (>30% decrease in blood pressure), reduced oxygenation (SpO2<85%), and anemia [2]. Risk of those critical events increases by congenital anomalies, prior neonatal medical conditions, patients requiring intensive care, and postmenstrual age [2].