Purpose of review: The expected difficult airway in children is a rare, but predictable entity, which can lead to life-threatening situations, when sufficient oxygenation and ventilation cannot be achieved. This review gives an overview on current techniques and recommendations on where, who, when, and how to treat children with expected difficult airway.
Recent findings: The equipment for a strategy on how to manage difficult airway seems to be less influential on outcomes compared with the expertise of the medical team. Nevertheless, fiberoptic intubation can be defined as the recent method of choice for the management of difficult airway in children as there is no clear evidence on supraglottic airways and indirect laryngoscope techniques.
Summary: The expected difficult airway in children is predictable by clinical signs and medical history in most of the cases and therefore anticipative. It should always be managed in specialized centers. In emergency situations, optimized face mask ventilation (aided by an oropharyngeal/nasopharyngeal airway) or ventilation via supraglottic airway devices or a nasopharyngeal tube can be most helpful skills until definitive airway management is available. These emergency techniques should be taught regularly in all anesthesia departments where children present for elective and nonelective surgery.