Henkel J, Ninke T
Klinik für Anaesthesiologie, LMU-Klinikum, LMU München, Marchioninistraße 15, 81377, München, Deutschland.
Anaesthesiologie. 2025 Aug 15. doi: 10.1007/s00101-025-01574-x.
Pediatric airway management can be much more difficult due to physiological and anatomical characteristics. Special attention should be paid to signs for a difficult airway when taking an anesthesiological anamnesis. This applies especially to children with syndromale diseases. During the induction of a general anesthesia, special attention should be paid to an optimal positioning of the child`s head (avoidance of a steep reclination or flexion of the head) and a correct "utilization" of the ventilation facemask. Securing the pediatric airway with a laryngeal mask can provide decisive advantages, especially for the less experienced as it is much simpler to manage. For endotracheal intubation apneic oxygenation should be used in every case, in order to prolong the apneic tolerance and to prevent oxygen desaturation. Video laryngoscopy should now preferentially be used in pediatric anesthesia, whereby both direct and indirect laryngoscopy-techniques can be performed. A change of the laryngoscope is no longer necessary and the first-pass success of the endotracheal tube is increased. The extubation can be performed with the child in both the supine or lateral position and also awake or asleep. The various possibilities have different advantages and disadvantages and should be used according to the preference of the anesthetist caring for the individual child.
由于生理和解剖学特征，小儿气道管理可能会困难得多。在进行麻醉病史采集时，应特别注意困难气道的体征。这尤其适用于患有综合征性疾病的儿童。在全身麻醉诱导期间，应特别注意儿童头部的最佳位置（避免头部过度后仰或屈曲）以及通气面罩的正确“使用”。使用喉罩确保小儿气道安全可提供决定性优势，尤其是对于经验较少者，因为其操作要简单得多。对于气管插管，在每种情况下都应使用无氧通气，以延长无氧耐受时间并防止氧饱和度下降。现在小儿麻醉中应优先使用视频喉镜，借此可同时进行直接和间接喉镜检查技术。不再需要更换喉镜，并且气管导管的首次插入成功率提高。拔管可在儿童仰卧位或侧卧位、清醒或睡眠状态下进行。各种可能性都有不同的优缺点，应根据照顾每个儿童的麻醉医生的偏好来使用。
