Paediatric difficult airway guidelines
The Paediatric Airway Guidelines Group, comprised of the Association of Paediatric Anaesthetists and the Difficult Airway Society, liaising with the RCoA, have produced the following three algorithms relating to the management of the unanticipated difficult airway in children aged 1 to 8 years.
They are:
- Difficult mask ventilation during routine induction of anaesthesia in a child aged 1 to 8 years
- Unanticipated difficult tracheal intubation during routine induction of anaesthesia in a child aged 1 to 8 years
- Cannot intubate and cannot ventilate (CICV) in a paralysed anaesthetised child aged 1 to 8 years.
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Background
Paediatric patients are looked after in many hospitals and specialist paediatric services are neither necessary nor appropriate in all settings. The target audience for these guidelines is for the non specialist anaesthetist who wishes to learn or maintain paediatric airway skills, rehearse unexpected difficult airway scenarios and teach good practice.
These guidelines are clinical, but are backed by a robust process. A formal paper giving all the background data used to develop these guidelines will be published in the near future.
Internationally it was clear that most units are using airway management guidelines for children which have been expanded from adult practice. The Paediatric Airway Guidelines Group therefore specifically developed these algorithms following an exhaustive process which involved a Delphi analysis (which ensured careful refection of each step of the pathway, and a grading of how confident an expert group was in endorsing each step), and an extensive literature review. Following this they conducted further external reviews, and placed the guideline on the APA website requesting comments-all views were considered. There was very little grade 1, (randomised control trial), evidence to support good practice in the management of the difficult paediatric airway, and guidance development was therefore essentially a clinical issue.
The Guidelines Group have taken a careful and thorough approach to review current practice. We hope these guidelines will be used widely, and would encourage feedback. We trust that, long term, they will be of use to all anaesthetists who manage children in day to day clinical practice, and those who teach safe airway techniques.
Paediatric Airway Guidelines Group Members
Ann Black, Chair: Paediatric Airway Guidelines Group, [email protected]
Paul Flynn, Royal National Orthopaedic Hospital, Stanmore
Mansukh Popat, DAS, John Radcliffe Hospital, Oxford
Helen Smith, Addenbrookes University Hospital, Cambridge
Mark Thomas, Great Ormond Street Hospital, London
Kathy Wilkinson, Norfolk and Norwich University Hospital (APA President)
Downloads
Difficult mask ventilation in children
GUIDELINES
DAS guidelines for awake tracheal intubation (ATI) in adults
Difficult Airway Society guidelines (2019) for awake tracheal intubation (ATI) in adults.
Guidelines for the management of tracheal intubation in critically ill adults
These guidelines (2017) describe a comprehensive strategy to optimize oxygenation, airway management, and tracheal intubation in critically ill patients, in all hospital locations.
Airway management in patients with suspected or confirmed cervical spine injury
Guidelines (2024) from the Difficult Airway Society (DAS), Association of Anaesthetists (AoA), British Society of Orthopaedic Anaesthetists (BSOA), Intensive Care Society (ICS), Neuro Anaesthesia and Critical Care Society (NACCS), Faculty of Prehospital Care and Royal College of Emergency Medicine (RCEM)
Management of difficult and failed intubation in obstetrics guidelines
This page hosts the Obstetric Anaesthetists’ Association and Difficult Airway Society’s 2015 guidelines for the management of difficult and failed tracheal intubation in obstetrics.
Paediatric difficult airway guidelines
The Paediatric Airway Guidelines Group, comprised of the Association of Paediatric Anaesthetists and the Difficult Airway Society, liaising with the RCoA, produced three algorithms relating to the management of the unanticipated difficult airway in children aged 1 to 8 years.
Management of tracheal extubation guidelines
The Difficult Airway Society has developed guidelines (2011) for the safe management of tracheal extubation in adult perioperative practice. The guidelines discuss the problems arising during extubation and recovery and promote a strategic, stepwise approach to extubation. They emphasise the importance of planning and preparation, and include practical techniques for use in clinical practice and recommendations for post-extubation care.
DAS guidelines for management of unanticipated difficult intubation in adults
The Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults. This was the result of three years of diligent work by our guidelines development team.
Management of haematoma after thyroid surgery guidelines
DAS, BAETS & ENT UK consensus guidelines (2021) for management of haematoma after thyroid surgery. Written in collaboration with our surgical and nursing colleagues, we hope they will improve patient safety, whilst promoting teamwork and organisational preparedness.