Pediatric Airway Guide

⚠️ Medical Disclaimer

This tool is a cognitive aid based on the 2022 ASA Practice Guidelines. It is for educational and simulation purposes only. It does not replace clinical judgment.

Pediatric Difficult Airway

Interactive algorithm based on ASA Figures 2 & 4.

Step 1: The Time Out

Before induction, confirm the following:

Induction Technique

Select the planned approach:

Ventilation Strategy

How will intubation be performed?

Larsen Maneuver Check

Required for Spontaneous Ventilation plan.

Perform Larsen Maneuver

Apply firm pressure (jaw thrust) for 5 seconds.

Did the patient respond?

(Increase in HR, RR, or Movement)

DO NOT PROCEED

Anesthetic depth is inadequate.

Action Required:

  • Deepen anesthesia (Propofol, Sevoflurane, etc.).
  • Wait for effect.
  • Repeat Larsen Maneuver.
  • Do not attempt airway instrumentation until no response is elicited.

Select Device

Attempt #1

Choose device for this attempt:

Attempt Outcome

Current Device

--

Attempt

1/10

Was the Airway Plan Successful?

Assess Ventilation

Look at the patient and monitors (SpO2, EtCO2).

Non-Emergency Pathway

Ventilation is adequate.

1

Consider calling for help.

2

Ensure appropriate anesthetic depth.

3
Guideline: Limit Attempts (3 + 1):
Be aware of increasing severe complication risk with each attempt.

Marginal Pathway

Ventilation is difficult.

Consider Supraglottic Airway (LMA)

If mask ventilation is difficult, try an LMA to improve oxygenation.

1

Call for Help! Treat Obstruction (Reposition, Oral Airway, 2-person mask).

2

Consider functional obstruction (laryngospasm?). Ensure paralysis.

Did ventilation improve?

EMERGENCY (CICO)

Cannot Intubate, Cannot Oxygenate

Rescue LMA

If not already placed, attempt LMA immediately to restore oxygenation.

ACT NOW

Do not fixate. Move to advanced techniques.

Execute Rescue Plan:

Rigid Bronchoscopy
Emergency Invasive Airway (Surgical/Needle)
ECMO (If available)

Airway Secured

Verify with Capnography (EtCO2).

Post-Event Debrief Checklist:

  • Identify what went well.
  • Identify system improvements.
  • Provide emotional support to the team.
  • Document difficult airway.

Emerging Patient

Plan failed.

• Maintain ventilation with face mask/LMA.
• Reverse anesthetic drugs if feasible.
• Formulate new plan (e.g., Awake Fiberoptic, Tracheostomy).

Based on ASA 2022 Guidelines: Pediatric Difficult Airway Infographic