Authors Keywords: syndromic paediatric airway, upper airway obstruction, difficult paediatric airway Abstract

The syndromic paediatric airway poses a potentially difficult airway due to the anatomical and functional difficulties that are seen in the management of this paediatric airway.1 A difficult airway is described as one where a trained anaesthesiologist experiences difficulty with face mask ventilation or difficulty with tracheal intubation, or both.2 The Mallampati scoring system for airway assessment is not always reliable in the paediatric population, therefore some clinicians prefer to use the Colorado Paediatric Airway Score (COPUR) since it is more detailed and possibly more reliable.2 The syndromes can be divided into conditions associated with hypoplasia of the mandible (micrognathia), which can result in a difficult intubation; midface hypoplasia, which can result in difficult bag-mask ventilation; macroglossia, which can cause difficult bag-mask ventilation and difficult intubation. Syndromes related to cervical spine abnormalities may cause difficulties with laryngoscopy and intubation.1

Syndromes associated with:
Micrognathia – include Pierre Robin sequence, Treacher Collins, Goldenhar
Midface hypoplasia – Apert syndrome, Crouzon, Pfeiffer
Macroglossia – Hurler’s syndrome, Beckwith-Wiedemann syndrome and Down syndrome
Cervical spine abnormalities – Klippel-Feil, Turner and Noonan’s syndrome

In the syndromic patient, proper planning and preparation are key in order to reduce the mortality and morbidity associated with the management of the difficult airway.3 The entire theatre team needs to be briefed on the plan for managing the airway. A thorough history and examination should be conducted on the patient, taking special note of any upper airway obstruction and its severity. Different airway equipment such as supraglottic devices, video laryngoscopes and fibreoptic bronchoscopes should be available in theatre depending on the cases, available resources and expertise of the airway manager.4 The primary goal for tackling the difficult airway is to keep the patient breathing spontaneously and to achieve a deep plane of anaesthesia before airway instrumentation. Knowledge of the difficult airway algorithm is key, as it allows one to manage the difficult airway in a stepwise approach.

Author Biography M Ngwenya, University of the Witwatersrand

Department of Anaesthesia, School of Clinical Medicine, Faculty of Health Sciences, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, South Africa

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