Evaluation of the pediatric airway: a review
DOI:
https://doi.org/10.18203/2349-3291.ijcp20223432Keywords:
Pediatric airway, Larynx, Trachea, Flexible nasopharyngolaryngoscopy, LaryngomalaciaAbstract
The airway in the pediatric age group is a complex structure that extends from the external nares to the junction of the larynx and trachea. The airway of pediatric patients has significant anatomical and physiological differences compared to the adult age group. The difficult airway in children is an important contributor to both morbidity and mortality of the patient. The symptoms and signs of pediatric patients with respiratory distress depend on the site and severity of the obstruction. It is essential to evaluate and localize the site and etiology of the obstruction of the pediatric airway. Pediatric otolaryngologists and anesthetists must have a strategy for managing the predicted difficult pediatric airway. Flexible nasopharyngolaryngoscopy is the gold standard method for predicting or knowing the difficult airway in children. The majority of pediatric patients who have difficult airways are identified preoperatively. Knowledge of the airway differences between the pediatric and adult ages will help clinicians anticipate and troubleshoot difficulties that may happen. This review article aims to discuss the evaluation of the pediatric airway including its anatomy and physiology of the airway, proper history taking, clinical examination, and investigations.
References
Swain SK, Choudhury J, Dubey D. Open safety pin in the pediatric airway: our experiences at a tertiary care teaching hospital. MGM J Med Sci. 2022;9(3):356-61.
Krishna SG, Bryant JF, Tobias JD. Management of the difficult airway in the pediatric patient. J Pediatr Intensive Care. 2018;7(03):115-25.
Swain SK, Behera IC, Sahoo L. Pediatric Laryngeal papillomatosis: Experiences at an Indian teaching hospital. J Heal Res Rev. 2019;6(3):114-121.
Hillman DR, Platt PR, Eastwood PR. The upper airway during anaesthesia. Bri J Anaesth. 2003;91(1):31-9.
Drummond GB. Controlling the airway-Skill and science. Anesthesiology. 2002; 97:771-3.
Engelhardt T, Fiadjoe JE, Weiss M, Baker P, Bew S, Echeverry Marín P et al. A framework for the management of the pediatric airway. Pediatr Anesth. 2019;29(10):985-92.
Sunder RA, Haile DT, Farrell PT, Sharma A. Pediatric airway management: Current practices and future directions. Paediatr Anaesth. 2012;22:1008-15.
Adewale L. Anatomy and assessment of the pediatric airway. Paediatr Anaesth. 2009;19(1):1-8.
Carr RJ, Beebe DS, Belani KG. The difficult pediatric airway. Sem Anesth Perioper Med Pain. 2001;20:219-27.
Abramson Z, Susarla S, Troulis M, Kaban L. Age-related changes of the upper airway assessed by 3-dimensional computed tomography. J Craniofac Surg. 2009;20(1):657-63.
Wood RE. Evaluation of the upper airway in children. Current Opin Pediatr. 2008;20(3):266-71.
Hung OR, Morris I: Dynamic anatomy of upper airway: Anessential paradigm. Can J Anaesth. 2000;47:295-8.
Dave MH, Kemper M, Schmidt AR, Both CP, Weiss M. Pediatric airway dimensions-a summary and presentation of existing data. Pediatr Anesth. 2019;29(8):782-9.
Swain SK, Sahu MC. Laryngeal Carcinoma in a Pediatric Patient-A Case Report. Iran J Otorhinolaryngol. 2019;31(105):251-5.
Wang J, Zhao Y, Yang W, Shen T, Xue P, Yan X et al. Correlations between obstructive sleep apnea and adenotonsillar hypertrophy in children of different weight status. Scientific Rep. 2019;9(1):1-7.
Holzman R. Anatomy and embryology of the paediatric airway. Anesthesiol Clin North America. 1998;16:707-27.
Swain SK, Behera IC, Mohanty JN. Laryngeal manifestation due to smoking among the pediatric age group–Our experiences at an Indian teaching hospital. Arch Med Heal Sci. 2019;7(2):186-90.
Swain SK, Mallik KC. Ear, nose, and throat foreign bodies in pediatric age. Med J Babylon. 2020;17(3):238-43.
Shorten GD, Opie NJ, Graziotti P, Morris I, Khangure M. Assessment of upper airway anatomy in awake, sedated and anaesthetised patients using magnetic resonance imaging. Anaesth Intens Care. 1994;22(2):165-9.
Ray RM, Senders CW. Airway management in the obese child. Pediatr Clin North Am. 2001;48:1055-63.
Kohler M, Lushington K, Couper R, Martin J, van den Heuvel C, Pamula Y et al. Obesity and risk of sleep related upper airway obstruction in Caucasian children. J Clin Sleep Med. 2008;4(2):129-36.
Swain SK, Sahu MC, Choudhury J, Ananda N. Adenotonsillectomy affecting quality of life in pediatric patients: Our experiences at a tertiary care teaching hospital of Eastern India. Ann Ind Academy Otorhinolaryngol Head Neck Surg. 2020;4(1):1-4.
Swain SK, Sahu MC, Choudhury J. Subglottic stenosis in paediatric patients. Pediatr Polska-Polish J Paediatr. 2018;93(1):80-5.
Roberts JT. Clinical Management of the Airway. Philadelphia, PA: W.B. Saunders Company. 1994.
Kawashima S, Niikuni N, Chia-hung L, Takahasi Y, Kohno M, Nakajima I et al. Cephalometric comparisons of craniofacial and upper airway structures in young children with obstructive sleep apnea syndrome. Ear Nose and Throat J. 2000;79(7):499-506.
Bradshaw K. Imaging the upper airways. Paediatr Respir Rev. 2001;2:46-56.
Swain SK, Behera IC. Performing laryngotracheobronchial procedure in coronavirus disease 2019 pandemic: A highly aerosol generating event in clinical practice. Matrix Sci Medica. 2021;5(1):1-6.
Rundo JV, Downey III R. Polysomnography. Handbook of clinical neurology. 2019; 160:381-92.
Cauldfield H. Investigations in paediatric obstructive sleepapnoea: do we need them? Int J Pediatr Otorhinolaryngol. 2003;67:(1):107-10.
Swain SK, Bhattacharyya B, Mohanty JN. Plastic bronchitis mimicking with foreign body bronchus in pediatric patient-A review. Indian J Child Heal. 2019;6(9):465-9.
Eisenberg JD, Wall MA. Pulmonary function testing in children. Clin Chest Med. 1987;8:666.
Wheeler M, Cote CJ, Todres ID, The Pediatric Airway in Cote CJ, Lerman J, Todres ID et al. eds. A Practice of Anaesthesia for Infants and Children, 4th edn. Philadelphia, PA: Saunders Elsevier. 2009;237-73.
Law JA, Broemling N, Cooper RM, Drolet P, Duggan LV, Griesdale DE et al. The difficult airway with recommendations for management–part 1-difficult tracheal intubation encountered in an unconscious/induced patient. Can J Anesth. 2013;60(11):1089-118.
Engelhardt T, Virág K, Veyckemans F, Habre W. 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. Bri J Anaesth. 2018;121(1):66-75.
Zalzal GH. Pediatric stridor and airway compromise. Le J Med Libanais. 1994;42(4):221-6.
Swain SK, Sahu MC, Mohanty S, Samal R, Baisakh MR. Management of laryngotracheal stenosis-Still remains a challenge for successful outcome. Apollo Med. 2016;13(2):102-7.
Don GW, Kirjavainen T, Broome C, Seton C, Waters KA. Site and mechanics of spontaneous, sleep-associated obstructive apnea in infants. J Applied Physiol. 2000;89(6):2453-62.
Rudman DT, Elmaraghy CA, Shiels WE, Wiet GJ. The role of airway fluoroscopy in the evaluation of stridor in children. Arch Otolaryngol Head Neck Surg. 2003;129(3):305-9.
Keller JL, Kacker A. Choanal atresia, CHARGE association, and congenital nasal stenosis. Otolaryngol Clin North Am. 2000;33:1343-51.
Swain SK, Choudhury J. Pediatric airway diseases. Ind J Heal Sci Biomed Res. 2019;12(3):196-201.
Swain SK, Sahu MC, Jena A. Congenital choanal atresia: our experiences in a tertiary care teaching hospital in eastern India. Pediatr Polska-Polish J Paediatr. 2018;93(1):57-61.
Swain SK, Das A, Behera IC, Bhattacharyya B. Tracheostomy among pediatric patients: A review. Ind J Child Heal. 2018;5(9):557-61.
Scott BL, Lam D, MacArthur C. Laryngomalacia and swallow dysfunction. Ear Nose Throat J. 2019;98(10):613-6.
Hassan MM, Emam AM, Mahmoud AM, Awad AH, Rezk I, Abou‐Taleb A et al. Congenital laryngomalacia: Is it an inflammatory disease? The role of vitamin D. Laryngoscope. 2020;130(2):448-53.
Swain SK. Pediatric tracheostomy: a review. Int J Contemporary Pediatr. 2022;9(2):218-23.
Swain SK, Choudhury J. Experience with the management of pediatric laryngopharyngeal reflux in an Indian teaching hospital. J Clin Sci. 2020;17(3):61-5.
Giotakis AI, Pototschnig C. Prognosis of congenital idiopathic abductor laryngeal paralysis with laryngeal electromyography. Laryngoscope. 2020;130(4):252-7.
Swain SK, Behera IC. Pediatric tracheostomy: A 10-year experience at a tertiary care teaching hospital in Eastern India. Ind J Heal Sci Biomed Res. 2022;15(3):224-9.
Ryan MA, Upchurch PA, Senekki-Florent P. Neonatal vocal fold paralysis. Neo Rev. 2020;21(5):308-22.
Swain SK, Das A, Sahu MC. Isolated laryngeal tuberculosis in a 10-year-old boy: A case report. Pediatr Polska-Polish J Paediatr. 2018;93(3):280-3.
Swain SK, Nahak B, Sahoo L, Munjal S, Sahu MC. Pediatric dysphonia-a review. Ind J Child Heal. 2019;6(1):1-5.