Authors: Garcia-Marcinkiewicz AG et al.
British Journal of Anaesthesia, Volume 131, Issue 1
Summary
This retrospective analysis from the multicentre Paediatric Difficult Intubation (PeDI) Registry examined the incidence, risk factors, and outcomes associated with difficult or impossible facemask ventilation in children who also experienced difficult tracheal intubation. The study included 5,453 paediatric patients in whom difficult airway management was recorded, focusing on patient and anesthetic factors identifiable before attempted facemask ventilation.
Difficult facemask ventilation occurred in 9% of patients. Infants were at particularly high risk, as were children with increased body weight, those below the 5th percentile for weight-for-age, and patients with specific craniofacial or anatomic abnormalities, including Treacher-Collins syndrome, glossoptosis, and limited mouth opening. These physical characteristics were strongly associated with difficulty or failure of facemask ventilation. In contrast, anesthetic inductions using facemask ventilation combined with opioid administration were associated with a lower risk of difficult mask ventilation.
Children who experienced difficult facemask ventilation had significantly higher rates of complications compared with those without mask ventilation difficulty. Rescue placement of a supraglottic airway device improved ventilation in the majority of cases, succeeding in approximately 71% of attempts. Administration of neuromuscular blocking agents was more often associated with improvement or no change in ventilation quality rather than deterioration, suggesting a potentially beneficial role in selected scenarios.
Key Points
• Difficult facemask ventilation occurred in about 1 in 10 children with difficult tracheal intubation.
• Infancy, abnormal weight parameters, and specific craniofacial or airway abnormalities increased risk.
• Difficult mask ventilation was associated with higher complication rates.
• Supraglottic airway devices successfully rescued ventilation in most cases.
• Neuromuscular blockade more often improved or did not worsen mask ventilation quality.
What You Should Know
In children with known or suspected difficult tracheal intubation, careful attention to physical examination findings can help identify those at risk for difficult or impossible facemask ventilation. Early consideration of supraglottic airway rescue and avoidance of prolonged ineffective mask ventilation may reduce complications and improve safety during pediatric airway management.
Thank you for allowing us to summarize this important contribution published in the British Journal of Anaesthesia.