Supraglottic Airway Devices for Pediatric Airway Management in the Emergency Department

Points & Pearls Excerpt

• Supraglottic airway devices (SGAs) are an alternative method for pediatric airway management. They are relatively safe, easy to learn how to use, and quick to place, with a high success rate and less complications than endotracheal intubation.
• SGAs can be used to secure a patient’s airway for oxygenation and ventilation in “can’t intubate, can’t ventilate” scenarios, and many SGAs can also be used to facilitate sequential intubation of the airway.
• Sizing for different SGAs varies by brand and is usually weight-based in pediatric patients.
• Laryngeal mask airways (LMAs) are commonly used SGAs, which can be placed without neuromuscular agents or laryngoscope. Frequent LMA repositioning may be required for pediatric patients.
• Acquired conditions can cause airway difficulties and may develop as a result of infection, allergic reactions, trauma, or foreign body aspiration.

Most Important References

• * Brimacombe J. The advantages of the LMA over the tracheal tube or facemask: a meta-analysis. Can J Anaesth. 1995;42(11):1017-1023. (Meta-analysis; 52 studies) DOI: 10.1007/bf03011075
• * Apfelbaum JL, Hagberg CA, Caplan RA, et al. Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology. 2013;118(2):251-270. (Practice guidelines) DOI: 10.1097/ALN.0b013e31827773b2
• * Detsky ME, Jivraj N, Adhikari NK, et al. Will this patient be difficult to intubate?: The Rational Clinical Examination Systematic Review. JAMA. 2019;321(5):493503. (Meta-analysis; 62 studies, 33,559 patients) DOI: 10.1001/jama.2018.21413