Paeds Vivas · acute-care-resuscitation-and-toxicology
Difficult paediatric airway and emergency front-of-neck access — branching viva
Branching viva on the difficult paediatric airway: anticipating and recognising difficulty, the recognise-oxygenate-escalate-rescue sequence, supraglottic-airway rescue, and emergency front-of-neck access for cannot-intubate-cannot-oxygenate.
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Target exams
RACP DCEMRCPCH ClinicalRCPSC Pediatrics
Prompt
Emergency department: a 2-year-old with Pierre Robin sequence and a documented previous difficult intubation is brought in with respiratory failure and needs intubation. The examiner asks: how do you anticipate and prepare for this airway and what is your plan — then branches to the child in whom the first laryngoscopy fails, to the child who deteriorates to cannot-intubate-cannot-oxygenate, and finally to how you prevent the next airway event.
Opening question
This 2-year-old with Pierre Robin sequence and a documented previous difficult intubation needs intubating for respiratory failure. How do you anticipate the difficulty, and what is your preparation and plan before induction? [2] [3]
References4ShowHide
- [1]Black AE, Flynn PE, Smith HL, et al. Development of a guideline for the management of the unanticipated difficult airway in pediatric practice. Paediatr Anaesth, 2015.PMID 25684039
- [2]Engelhardt T, Weiss M. A child with a difficult airway: what do I do next? Curr Opin Anaesthesiol, 2012.PMID 22499162
- [3]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.PMID 33812665
- [4]Tsuboi K, Tsuboi N, Suzuki N, et al. Emergency Front-Of-Neck Access in the Pediatric Intensive Care Unit: Development of an Institutional Protocol. Paediatr Anaesth, 2026.PMID 41195791