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Review
. 2025 Feb;39(1):123-133.
doi: 10.1007/s00540-024-03428-z. Epub 2024 Nov 18.

Airway management in pediatrics: improving safety

Lea Zimmermann #  1 , Federica Maiellare #  2 , Francis Veyckemans  3 , Alexander Fuchs  1 , Tommaso Scquizzato  4 , Thomas Riva #  1 , Nicola Disma #  5
Affiliations
Review

Airway management in pediatrics: improving safety

Lea Zimmermann et al. J Anesth. 2025 Feb.

Abstract

Airway management in children poses unique challenges due to the different anatomy, physiology, and pathophysiology across the pediatric age span. The recently published joint European Society of Anaesthesiology and Intensive Care-British Journal of Anaesthesia (ESAIC-BJA) neonatal and infant airway management guidelines provide recommendations and suggestions to support clinicians in deciding the best strategy. These guidelines represent a framework with the most recent and up-to-date evidence, from the initial assessment to the management of normal and difficult airways up to the extubation phase. However, such guidelines have intrinsic limitations due to the lack of supporting evidence in various fields of airway management. Pediatric institutions should adopt guidelines after careful internal review according to the local circumstances, including caseload, equipment and expertise. The current narrative review focused on providing references and practical tips on pediatric airway management, which is still not completely elucidated. Moreover, the authors put particular emphasis on the influence of human factors on the overall success of tracheal intubation, the incidence of complications, and the outcomes for patients.

Keywords: Airway; Anesthesia; Complications; Intubation; Pediatric.

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Conflict of interest statement

Declarations. Conflict of interest: Authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
The airway checklist applied at the Bern University Hospital. This checklist should be filled before airway management and induction of anesthesia, for every patient
Fig. 2
Fig. 2
Example of the difficult airway trolley at Bern University Hospital, mirroring the cognitive aids
Fig. 3
Fig. 3
Infographics representing the most relevant steps for pediatric airway management
See this image and copyright information in PMC

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