Pediatr. praxi. 2025;26(4):203-208 | DOI: 10.36290/ped.2025.039

Airway management in paediatric patients

MUDr. Eva Klabusayová, Ph.D., DESAIC1, 2, *, MUDr. Tereza Bönischová1, 2, *, MUDr. Hana Harazim, Ph.D.1, 2, prof. MUDr. Petr Štourač, Ph.D., MBA, LL.M., FESAIC1, 2
1 Klinika dětské anesteziologie a resuscitace, Fakultní nemocnice Brno a Lékařská fakulta Masarykovy univerzity v Brně
2 Ústav simulační medicíny, Lékařská fakulta Masarykovy univerzity v Brně

Airway management is a fundamental skill that should be mastered by every physician that may encounter critically ill child. Key procedures include airway opening, proper head positioning, and effective ventilation using a face mask and self-inflating bag with two providers. Depending on the clinical situation, a wide range of airway devices can be used, from supraglottic tools (e. g., laryngeal mask) to infraglottic tools (e. g., tracheal intubation). These techniques have specific considerations in paediatric patients, and their use should always be carefully evaluated with regard to patient safety as the top priority.

Keywords: paediatric patient, airway management, face mask, laryngeal mask, orotracheal intubation.

Accepted: August 20, 2025; Published: September 26, 2025  Show citation

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Klabusayová DESAIC E, Bönischová T, Harazim H, Štourač FESAIC P. Airway management in paediatric patients. Pediatr. praxi. 2025;26(4):203-208. doi: 10.36290/ped.2025.039.
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References

  1. . ERC | Bringing resuscitation to the world. Accessed May 23, 2025. Available from: https://www.erc.edu/courses/european-paediatric-advanced-life-support.
  2. . Tobias JD. Pediatric airway anatomy may not be what we thought: implications for clinical practice and the use of cuffed endotracheal tubes. Paediatr Anaesth. 2015;25(1):9-19. doi:10.1111/pan.12528. Go to original source... Go to PubMed...
  3. . Paal P, Niederklapfer T, Keller C, et al. Head-position angles in children for opening the upper airway. Resuscitation. 2010;81(6):676-678. doi:10.1016/j.resuscitation.2010.01.022. Go to original source... Go to PubMed...
  4. . Harless J, Ramaiah R, Bhananker SM. Pediatric airway management. Int J Crit Illn Inj Sci. 2014;4(1):65-70. doi:10.4103/2229-5151.128015. Go to original source... Go to PubMed...
  5. . Positioning Infants and Children for Airway Management. Pediatric Anesthesia Digital Handbook. Accessed March 11, 2025. https://www.maskinduction.com/positioning-infants-and-children-for-airway-management.html.
  6. . Okada Y, Nakayama Y, Hashimoto K, et al. Ramped versus sniffing position for tracheal intubation: A systematic review and meta-analysis. Am J Emerg Med. 2021;44:250-256. doi:10.1016/j.ajem.2020.03.058. Go to original source... Go to PubMed...
  7. . CPR Guidelines 2025. Accessed May 23, 2025. Available from: https://cprguidelines.eu/guidelines/paediatric-life-support.
  8. . Habre W, Disma N, Virag K, et al. Incidence of severe critical events in paediatric anaesthesia (APRICOT): a prospective multicentre observational study in 261 hospitals in Europe. Lancet Respir Med. 2017;5(5):412-425. doi:10.1016/S2213-2600(17)30116-9. Go to original source... Go to PubMed...
  9. . Disma N, Virag K, Riva T, et al. Difficult tracheal intubation in neonates and infants. NEonate and Children audiT of Anaesthesia pRactice IN Europe (NECTARINE): a prospective European multicentre observational study. Br J Anaesth. 2021;126(6):1173-1181. doi:10.1016/j.bja.2021.02.021. Go to original source... Go to PubMed...
  10. . Klucka J, Kosinova M, Kratochvil M, et al. Difficult airway prediction in paediatric anaesthesia (Diffair): Prospective observational study. Biomed Pap. 2021;165(3):298-304. doi:10.5507/bp.2020.020. Go to original source... Go to PubMed...
  11. . Garcia-Marcinkiewicz AG, Lee LK, Haydar B, et al. Difficult or impossible facemask ventilation in children with difficult tracheal intubation: a retrospective analysis of the PeDI registry. Br J Anaesth. 2023;131(1):178-187. doi:10.1016/j.bja.2023.02.035. Go to original source... Go to PubMed...
  12. . Qian X, Hu Q, Zhao H, et al. Determination of the optimal inspiratory pressure providing adequate ventilation while minimizing gastric insufflation using real-time ultrasonography in Chinese children: a prospective, randomized, double-blind study. BMC Anesthesiol. 2017;17(1):126. doi:10.1186/s12871-017-0417-0. Go to original source... Go to PubMed...
  13. . Disma N, Asai T. Preventing difficult facemask ventilation in children: all is well that starts well. Br J Anaesth. 2023;131(1):20-22. doi:10.1016/j.bja.2023.04.015. Go to original source... Go to PubMed...
  14. . Schmölzer GM. Face mask or laryngeal mask during positive pressure ventilation for term newborns: Is one preferable than the other? Resuscitation. 2022;171:96-97. doi:10.1016/j.resuscitation.2022.01.002. Go to original source... Go to PubMed...
  15. . Diggikar S, Krishnegowda R, Nagesh KN, et al. Laryngeal mask airway versus face mask ventilation or intubation for neonatal resuscitation in low-and-middle-income countries: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed. 2023;108(2):156-163. doi:10.1136/archdischild-2022-324472. Go to original source... Go to PubMed...
  16. . Drake-Brockman TFE, Ramgolam A, Zhang G, et al. The effect of endotracheal tubes versus laryngeal mask airways on perioperative respiratory adverse events in infants: a randomised controlled trial. Lancet Lond Engl. 2017;389(10070):701-708. doi:10.1016/S0140-6736(16)31719-6. Go to original source... Go to PubMed...
  17. . Licina A, Chambers NA, Hullett B, et al. Lower cuff pressures improve the seal of pediatric laryngeal mask airways. Pediatr Anesth. 2008;18(10):952-956. doi:10.1111/j.1460-9592.2008.02706.x. Go to original source... Go to PubMed...
  18. . Paediatric difficult airway guidelines. Difficult Airway Society. Accessed December 16, 2024. Available from: https://das.uk.com/guidelines/paediatric-difficult-airway-guidelines/
  19. . Jagannathan N, Sohn LE, Sawardekar A, et al. A randomised trial comparing the laryngeal mask airway SupremeTM with the laryngeal mask airway UniqueTM in children. Anaesthesia. 2012;67(2):139-144. doi:10.1111/j.1365-2044.2011.06960.x. Go to original source... Go to PubMed...
  20. . Templeton TW, Hoke LK, Templeton LB, et al. A comparison of 3 ventilation strategies in children younger than 1 year using a Proseal laryngeal mask airway: a randomized controlled trial. J Clin Anesth. 2016;35:502-508. doi:10.1016/j.jclinane.2016.07.042. Go to original source... Go to PubMed...
  21. . Frerk C, Mitchell VS, McNarry AF, et al. Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults. BJA Br J Anaesth. 2015;115(6):827-848. doi:10.1093/bja/aev371. Go to original source... Go to PubMed...
  22. . Disma N, Asai T, Cools E, et al. Airway management in neonates and infants: European Society of Anaesthesiology and Intensive Care and British: Journal of Anaesthesia: joint guidelines. Eur J Anaesthesiol EJA. 2024;41(1):3. doi:10.1097/EJA.0000000000001928. Go to original source... Go to PubMed...
  23. . Varghese E, Kundu R. Does the Miller blade truly provide a better laryngoscopic view and intubating conditions than the Macintosh blade in small children? Pediatr Anesth. 2014;24(8):825-829. doi:10.1111/pan.12394. Go to original source... Go to PubMed...
  24. . Černý V, Chrobok V, Klučka J, et al. Zajištění obtížných dýchacích cest u dospělých a dětí. Anesteziol Intenziv Medicína. 2019;30(3-4):173-186.
  25. . Klabusayová E, Klučka J, Kosinová M, et al. Videolaryngoscopy vs. Direct Laryngoscopy for Elective Airway Mana­gement in Paediatric Anaesthesia: A prospective randomised controlled trial. Eur J Anaesthesiol. 2021;38(11):1187-1193. doi:10.1097/EJA.0000000000001595. Go to original source... Go to PubMed...
  26. . Klabusayová E, Klučka J, Kratochvíl M, et al. Airway Management in Pediatric Patients: Cuff-Solved Problem? Child Basel Switz. 2022;9(10):1490. doi:10.3390/children9101490. Go to original source... Go to PubMed...
  27. . De Orange FA, Andrade RG, Lemos A, et al. Cuffed versus uncuffed endotracheal tubes for general anaesthesia in children aged eight years and under. Cochrane Database Syst Rev. 2017;11(11):CD011954. doi:10.1002/14651858.CD011954.pub2 Go to original source... Go to PubMed...
  28. . Chambers NA, Ramgolam A, Sommerfield D, et al. Cuffed vs. uncuffed tracheal tubes in children: a randomised controlled trial comparing leak, tidal volume and complications. Anaesthesia. 2018;73(2):160-168. doi:10.1111/anae.14113. Go to original source... Go to PubMed...
  29. . Mhamane R, Dave N, Garasia M. Use of Microcuff® endotracheal tubes in paediatric laparoscopic surgeries. Indian J Anaesth. 2015;59(2):85-88. doi:10.4103/0019-5049.151367. Go to original source... Go to PubMed...
  30. . Zander D, Grass B, Weiss M, et al. Cuffed endotracheal tubes in neonates and infants of less than 3 kg body weight - A retrospective audit. Pediatr Anesth. 2021;31(5):604-610. doi:10.1111/pan.14104. Go to original source... Go to PubMed...
  31. . Schneider J, Mulale U, Yamout S, et al. Impact of monitoring endotracheal tube cuff leak pressure on postextubation stridor in children. J Crit Care. 2016;36:173-177. doi:10.1016/j.jcrc.2016.06.033. Go to original source... Go to PubMed...
  32. . Weiss M, Dullenkopf A, Fischer JE, et al. Prospective randomized controlled multi-centre trial of cuffed or uncuffed endotracheal tubes in small children#. Br J Anaesth. 2009;103(6):867-873. doi:10.1093/bja/aep290. Go to original source... Go to PubMed...
  33. . Kneyber MCJ, de Luca D, Calderini E, et al. Recommendations for mechanical ventilation of critically ill children from the Paediatric Mechanical Ventilation Consensus Conference (PEMVECC). Intensive Care Med. 2017;43(12):1764-1780. doi:10.1007/s00134-017-4920-z. Go to original source... Go to PubMed...
  34. . Tareerath M, Mangmeesri P. Accuracy of Age-Based Formula to Predict the Size and Depth of Cuffed Oral Preformed Endotracheal Tubes in Children Undergoing Tonsillectomy. Ear Nose Throat J. 2023;102(3):193-197. doi:10.1177/0145561320980511. Go to original source... Go to PubMed...
  35. . Russo SG, Becke K. Expected difficult airway in children. Curr Opin Anaesthesiol. 2015;28(3):321-326. doi:10.1097/ACO.0000000000000198. Go to original source... Go to PubMed...
  36. . Fritscherová Š, Dostálová K, Koutná J, et al. Validace faktorů predikce obtížné intubace. Anesteziol Intenziv Medicína. 2012;(2):69-74.
  37. . Zheng Z, Wang X, Du R, et al. Effectiveness of ultrasonic measurement for the hyomental distance and distance from skin to epiglottis in predicting difficult laryngoscopy in children. Eur Radiol. 2023;33(11):7849-7856. doi:10.1007/s00330-023-09757-z. Go to original source... Go to PubMed...
  38. . Yüksek ME, Pirbudak L, Sen E, et al. The use of ultrasound in the assessment of difficult laryngoscopy in children. Ann Clin Anal Med. 2023;14(06):507-511. doi:10.4328/ACAM.21606. Go to original source...
  39. . Engelhardt T, Virag K, Veyckemans F, APRICOT Group of the European Society of Anaesthesiology Clinical Trial Network. Airway management in paediatric anaesthesia in Europe-insights from APRICOT (Anaesthesia Practice In Children Observational Trial): a prospective multicentre observational study in 261 hospitals in Europe. Br J Anaesth. 2018;121(1):66-75. doi:10.1016/j.bja.2018.04.013. Go to original source... Go to PubMed...
  40. . Klabusayová E, Bönischová T, Harazim H, et al. Rok 2024 v přehledu - Anestezie a intenzivní péče v pediatrii. Anesteziol Intenziv Medicína. 2024;35(5):311-313. doi:0.36290/aim.2024.052. Go to original source...
  41. . Jagannathan N, Sequera-Ramos L, Sohn L, et al. Elective use of supraglottic airway devices for primary airway mana­gement in children with difficult airways †. Br J Anaesth. 2014;112(4):742-748. doi:10.1093/bja/aet411. Go to original source... Go to PubMed...




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