Availability and Practice Patterns of Videolaryngoscopy and Adaptation of Apneic Oxygenation in Pediatric Anesthesia: A Cross‐Sectional Survey of Pediatric Anesthesiologists

• Published in: Pediatric anesthesia Vol. 35; no. 6; pp. 460 - 468
• Main Authors: Bai, Wenyu, Koppera, Prabhat, Yuan, Yuan, Mentz, Graciela, Pearce, Bridget, Therrian, Megan, Reynolds, Paul, Brown, Sydney E. S.
• Format: Journal Article
• Language: English
• Published: France Wiley Subscription Services, Inc 01.06.2025; John Wiley and Sons Inc
• Subjects: Anesthesia; Anesthesia - methods; Anesthesiologists - statistics & numerical data; Apnea - therapy; apneic oxygenation; Child; Cross-Sectional Studies; difficult tracheal intubation; Humans; Infant, Newborn; Intubation; Intubation, Intratracheal - methods; Laryngoscopy; Laryngoscopy - methods; Medical personnel; Pediatric Anesthesia; Pediatrics; Pediatrics - methods; Practice Patterns, Physicians' - statistics & numerical data; Research Report; survey; Surveys and Questionnaires; Video-Assisted Techniques and Procedures; videolaryngoscopy; apneic oxygenation; survey; pediatric anesthesia; videolaryngoscopy; difficult tracheal intubation
• ISSN: 1155-5645; 1460-9592; 1460-9592
• DOI: 10.1111/pan.15079

ABSTRACT Background Videolaryngoscopy (VL) and apneic oxygenation are highly recommended and increasingly used in pediatric anesthesia practice; yet, availability, use in recommended clinical settings (e.g., neonates, airway emergencies, and out‐of‐operating‐room tracheal intubation), and the association of VL availability with how pediatric anesthesiologists define difficult intubation have not been explored. Method An electronic survey was distributed to the members of several international pediatric anesthesia societies to examine the availability and practice patterns of VL and to explore the criteria used to define a difficult tracheal intubation in children in the context of VL. Results The response rate was 12.9%. VL was reported to be “most likely available” in main pediatric operating rooms and offsite locations 93% and 80.1% of the time, respectively. Fifty‐seven percent of participants would select VL first when anticipating a difficult tracheal intubation; nearly 30% of respondents would choose direct laryngoscopy first and VL as a backup in this scenario. One‐third of subjects would select VL as their first choice for nonoperating room (non‐OR) emergency tracheal intubation and for premature or newborn infants, regardless of anticipated difficulty with intubation. Thirty percent of subjects reported using apneic oxygenation during difficult laryngoscopy. Institutional VL availability was not associated with how providers defined difficult tracheal intubation. Conclusion VL is highly available, but the adoption of VL and apneic oxygenation for managing difficult tracheal intubation was lower than expected, given recent recommendations by pediatric anesthesia societies. There was heterogeneity in how difficult intubation was defined, resulting in a possible patient safety risk.