The condition of “cannot intubate cannot ventilate” is very rare and stressful
scenario in paediatric patients, requiring a deep knowledge about anatomic and
physiologic features as well as their congenital anomalies. Their anatomical differences
as compared to adults imply different laryngoscopy techniques and, for this reason, the
endotracheal tube placement is more difficult than in adults. Moreover, paediatric
patients have increased oxygen consumption and a reduced functional residual
capacity, so the apnea time decreases considerably. In healthy infants under the age of
6 months, with the previous preoxygenation, the saturation pulse oximetry reaches 90%
in 90 seconds, while in adults, it happens at 6 minutes [1]. The respiratory events are
very common in the paediatric population during general anaesthesia induction. There
are some risk factors such as age of under 12 months and the experience and skills of
the anaesthesiologist [2]. The hypoxemia (airway management) is one of the causes of
cardiac arrest in the operating-room (27%), while failed endotracheal intubation
appears in 7% of the cases [3]. All paediatric anaesthesiologists should be warned
about the anatomical and physiological characteristics of the paediatric airway [4].
Keywords: Combitube, Cricoid pressure, EC position, Extubation, Flexible
fiberoptic bronchoscope, Functional residual capacity, Gastric distension,
Laryngeal braking, Laryngeal mask airway, Laryngospasm, Light wand, Miller
laryngoscope, Sniffing position, Lemon score , Sugammadex, Two hands
ventilation, Uncuffed ETT, Videolaryngoscopy.
