Oral endotracheal intubation in pediatric anesthesia

ABSTRACT

Pediatric airway management has been both an integral part of routine anesthesia practice and one of its greatest challenges. Traditionally, it has been thought that the pediatric larynx is funnel-shaped, with the narrowest portion being situated at the cricoid cartilage; the choice of endotracheal tube type, size and insertion depth has been based on this concept. Uncuffed endotracheal tubes have typically been advocated for children younger than 8 years. However, it has recently been determined that the pediatric larynx is conical-shaped, with the narrowest portion of the larynx being situated at the rima glottidis. Therefore, there has been a shift in pediatric airway management, and cuffed tubes have been used without significant differences in post-extubation complication rates. It is critical to use the appropriate type and size of endotracheal tube, as well as to ensure proper insertion depth and adequate visualization of airway structures. Here, we introduce and discuss the optimal type, size, and insertion depth of endotracheal tube, and compare direct and video laryngoscopy.