Overview
Purpose and goals of tracheal intubation
Tracheal intubation (TI) is a core resuscitative procedure
for critically ill children. The primary goals are:
- Rapid, safe airway placement: Secure an
artificial airway in the trachea.
- Physiologic stability: Prevent hypoxemia,
hypercapnia, bradycardia, and hypotension.
- Support critical functions: Stabilize
oxygenation, ventilation, airway protection, and neurologic
status.
Indications for tracheal intubation
TI is indicated when there is actual or impending failure of:
- Oxygenation
- Ventilation
- Neuromuscular respiratory drive
- Airway protective reflexes
It is also appropriate when:
- Clinical trajectory suggests
deterioration or need for prolonged support.
- Transport or procedures require a secure
airway.
- Neurologic failure is present (e.g.,
traumatic brain injury, status epilepticus, cardiac arrest).
Key point: In pediatric
emergency care, neurologic failure and trauma are major
drivers of TI, rather than primary respiratory failure alone.
Pediatric-specific factors
Anatomic and physiologic considerations
Pediatric airway anatomy and physiology differ
significantly from adults and directly influence intubation
technique, equipment selection, and the risk of adverse
events.
Anatomic features
- Smaller airway diameter: Higher risk
of obstruction and limited visualization.
- Adenoidal hypertrophy: Common in
young children; can impede nasal and oral access.
- Developing teeth and tooth buds:
Susceptible to injury during laryngoscopy.
- Primary teeth: Easily avulsed or
aspirated with poorly controlled instrumentation.
- Large tongue: Tongue is large
relative to the oropharynx, obstructing the view.
- Superior larynx: Larynx lies higher
(C3–C4 in infants vs. C4–C5 in adults), making angles
more acute.
- Weaker hyoepiglottic ligament:
Lifting the epiglottis via the vallecula is less
efficient than in adults.
- Long, floppy epiglottis: Narrow and
acutely angled, more likely to obscure the glottic
opening.
- Narrowest point: Historically
described at the cricoid cartilage, but current evidence
supports the glottis (vocal cords) as the functionally
narrowest region, supporting the routine use of cuffed
endotracheal tubes in all ages.
Physiologic features
- Smaller lungs and fewer alveoli:
Reduced oxygen reservoir and gas exchange surface area.
- High chest wall compliance:
Cartilaginous chest wall with poor recoil increases work
of breathing.
- Closing volume > FRC: Terminal
bronchioles may close above functional residual
capacity, predisposing to atelectasis and collapse.
- Higher metabolic rate: Increased
oxygen consumption, especially in infants, leading to
rapid desaturation during apnea.
- High vagal tone: Greater tendency
for bradycardia with hypoxia, suctioning, or
laryngoscopy.
Bottom line:
Children desaturate quickly and are more prone to
physiologic collapse during TI. Meticulous preoxygenation
and minimizing apnea time are critical.
Quality & safety
Provider exposure, safety profile, and training
Low frequency and skill maintenance
Pediatric TI is relatively infrequent, even in high-volume
pediatric emergency departments. Many clinicians perform only
a small number of intubations per year, and some perform none,
leading to potential skill decay and variability in
performance.
Trainee exposure has declined, and observational studies
show modest success rates for residents and fellows on their
first attempts. These patterns highlight the importance of
structured training and careful selection of the initial
intubator when a child requires TI.
Adverse events and physiologic instability
Recent video-based and registry data suggest that serious
physiologic changes during pediatric TI are more common than
previously appreciated:
- Desaturation (< 90%) occurs in a
substantial proportion of emergency TIs.
- Cardiovascular instability (bradycardia,
hypotension) is seen in a notable minority of cases.
- Cardiac arrest (often from hypoxia) can
occur, underscoring the high-stakes nature of the procedure.
High-risk profile:
TI in children is a low-frequency, high-stakes procedure with
meaningful risk of hypoxemia and hemodynamic compromise,
especially with prolonged or multiple attempts.
Approaches to improving safety
To mitigate risk and maintain competence, departments can:
- Use structured airway algorithms and
clearly designate the initial and backup operators.
- Incorporate video laryngoscopy as a
primary or early tool to improve glottic visualization.
- Review airway performance via registries,
chart review, and video when available.
- Invest in simulation-based education with
deliberate practice and team-based scenarios.
Low-frequency procedure
High-stakes Simulation
& QA Risk of
hypoxia & bradycardia
Noninvasive strategies
Alternatives to endotracheal intubation
Before proceeding to TI, consider whether noninvasive
support can stabilize the child, particularly in:
- Hypoxic or hypercarbic respiratory failure
where work of breathing is high but airway protection is
intact.
- Predicted difficult airway where TI may
be hazardous or prolonged.
- Situations where sedation/paralysis may
carry excessive risk.
High-flow nasal cannula (HFNC)
HFNC delivers heated, humidified oxygen at high flows that
can meet or exceed the patient’s inspiratory demands.
- FiO₂: 21–100%, with adjustable fraction
of inspired oxygen.
- Age-based flow rates: Smaller children
often receive weight-based flows; older children and
adults may receive fixed flows (e.g., up to 60 L/min in
adults).
- Mechanisms: Reduced room air
entrainment, nasopharyngeal dead space washout, and
low-level positive airway pressure.
- Comfort: Typically better tolerated
than masks; allows speaking and feeding in appropriate
patients.
- Safety: Excellent overall safety
profile; barotrauma is rare and mostly limited to case
reports.
Clinical use: HFNC is
commonly used as first-line support in conditions such as
bronchiolitis, pneumonia, and some asthma exacerbations when
work of breathing is increased but immediate intubation is
not yet required.
Noninvasive Support
High-Flow Nasal Cannula (HFNC)
HFNC provides heated, humidified oxygen at high flows that
meet or exceed the patient’s inspiratory demand. It improves
oxygenation, reduces work of breathing, and is well tolerated
across pediatric age groups.
Suggested HFNC Flow Rates
Clinical
note: Cannula size should occupy < 50% of
the nares to avoid inadvertent CPAP.
| Patient Weight (kg) |
Starting Flow (L/min) |
Maximum Flow (L/min) |
| < 5 |
6 |
8 |
| 5–10 |
8 |
15 |
| 10–20 |
15–20 |
20 |
| 20–40 |
25–30 |
40 |
| > 40 |
25–30 |
40–60 |
Clinical Pearls
- Many centers use 1–2 L/kg/min as a
starting point for infants and toddlers.
- Reassess work of breathing and oxygenation every 5–10
minutes.
- Failure to improve within 30–60 minutes
should prompt escalation.
Noninvasive Support
Noninvasive Ventilation (NIV)
NIV provides mechanical respiratory support without
endotracheal intubation. It includes CPAP
(continuous positive airway pressure) and BPAP
(bilevel positive airway pressure). Both can be delivered
through nasal masks, full-face masks, or helmet interfaces.
CPAP
Best for:
- Hypoxemic respiratory failure
- Upper airway obstruction (e.g., croup, post-extubation
stridor)
Typical settings:
- 5–10 cm H₂O continuous pressure
BPAP
Best for:
- Hypercarbic respiratory failure
- Severe hypoxemia requiring higher mean airway pressures
- Neuromuscular weakness or fatigue
Typical settings:
- IPAP: 8–22 cm H₂O
- EPAP: 5–10 cm H₂O
- Optional backup rate for apnea/hypopnea
Interface
selection is critical: choose the most comfortable
option with minimal leak.
Advantages of NIV
- May prevent need for intubation in selected patients.
- Allows delivery of supplemental oxygen and
inhaled medications.
- Avoids complications of sedation, paralysis, and mechanical
ventilation.
Contraindications
- Immediate need for intubation
- Impaired mental status or inability to
protect airway
- Facial trauma or burns
- Upper GI bleeding
- Untreated pneumothorax
- Escalating vasopressor requirement
Complications
- Major: barotrauma, aspiration, hemodynamic
compromise
- Minor: skin breakdown, eye irritation,
nasal trauma, gastric distention
Clinical pearl: Most
children tolerate NIV with coaching and patience; mild
anxiolysis may help.
Advanced Airway
Approach to Endotracheal Intubation
Rapid sequence intubation (RSI) is the preferred method for
securing the airway in critically ill children. RSI improves
intubating conditions and increases first-attempt success
compared with sedation-only approaches. It involves the
near-simultaneous administration of a sedative and a
neuromuscular-blocking agent (NMBA) to produce unconsciousness,
immobility, and suppression of airway reflexes.
RSI vs Modified RSI vs Sedation-Only
- Pure RSI: No bag-mask ventilation (BMV)
during apnea to minimize aspiration risk in presumed
non-fasted patients.
- Modified/Controlled RSI: Allows gentle
BMV after medications to prevent hypoxemia or
hypercarbia—often necessary in pediatrics due to rapid
desaturation.
- Sedation-only intubation: Consider when
maintaining spontaneous respirations is critical (e.g., upper
airway obstruction, anticipated difficult airway).
Clinical pearl: Children
desaturate quickly—modified RSI with controlled ventilation is
often safer than strict “no BMV” RSI.
The 7 Ps of RSI
- Preparation
- Preoxygenation
- Pretreatment / Pre-optimization
- Paralysis with induction
- Positioning
- Placement of the ETT
- Post-intubation management
Preparation
Equipment
Anticipating the need for escalating airway support and
ensuring all equipment is ready is essential for safe pediatric
intubation. Oxygen sources, passive oxygenation devices, and a
functioning bag-valve-mask (BVM) must be immediately available.
Required Equipment
- Oxygen source and delivery devices (nasal cannula, NRB,
HFNC)
- Bag-valve-mask with appropriately sized masks
- Oral and nasal airways
- Endotracheal tubes (ETTs), cuffed and uncuffed
- Stylets sized for the selected ETT
- Direct laryngoscope blades and handles
- Videolaryngoscope (VL) with pediatric blades
- Capnography (ETCO₂) for confirmation
SOAP ME Checklist
- Suction
- Oxygen
- Airway equipment
- Positioning
- Monitors and medications
- End-tidal CO₂
Many centers now use pre-intubation
checklists to ensure readiness of equipment,
personnel, and medications.
Airway Equipment
Endotracheal Tubes (ETTs)
Both cuffed and uncuffed ETTs are used in pediatrics. Modern
evidence supports the safety of cuffed tubes beyond the newborn
period, and they are now widely recommended.
Cuffed vs Uncuffed Tubes
- Historically, uncuffed tubes were preferred due to the
belief that the subglottis was the narrowest point.
- Newer imaging and bronchoscopic data show the pediatric
airway is often elliptical, and the
glottis—not the cricoid—is the functionally narrowest region.
- Modern cuffed tubes have low-profile, distally
positioned cuffs that avoid laryngeal structures.
- Cuffed tubes reduce the need for tube exchanges and do not
increase rates of post-extubation stridor or long-term
complications.
PALS and anesthesia guidelines:
Cuffed ETTs are safe and preferred in most children beyond the
newborn period.
When Cuffed Tubes Are Favored
- Airway edema or evolving airway diameter (e.g., burns,
angioedema)
- Risk of aspiration
- Need for high ventilator pressures (e.g., bronchiolitis,
asthma, chronic lung disease)
Cuff Pressure
- Maintain < 20–30 cm H₂O to avoid
mucosal ischemia.
- Use a cuff manometer—“feeling the balloon” is unreliable.
ETT Sizing
ETT sizes are based on internal diameter (mm). Methods include:
- Length-based resuscitation tape
- Pediatric airway apps
- Age-based formulas
Age-Based Formulas
- Uncuffed: 4 + (age in years / 4)
- Cuffed: 3.5 + (age in years / 4)
Always have one tube size smaller and one size larger
available.
Stylets
- Provide rigidity and shape for ETT guidance.
- Essential for videolaryngoscopy due to indirect tube
passage.
- Ensure the stylet does not extend beyond the ETT
tip or the Murphy eye.
- Bend the proximal end over the adapter to prevent migration.
Airway Equipment
Direct Laryngoscopes
Direct laryngoscopy (DL) uses a handle and blade to create a
direct line of sight to the glottis. Blade choice depends on
patient age, anatomy, and clinician preference.
Curved vs Straight Blades
- Curved blades (Macintosh): sit in the
vallecula, lifting the epiglottis via the hyoepiglottic
ligament.
- Straight blades (Miller): directly lift
the epiglottis; often preferred in infants and young children
with large, floppy epiglottises.
Blade Size Selection
- Size 1: infants < 2 years
- Size 2: toddlers and young children (~2+ years)
- Size 3: older children/adolescents (~10–12 years)
Tip: Choose a blade
approximately equal to the distance from the upper incisors to
the angle of the mandible when age is uncertain.
Advanced Airway
Video Laryngoscopes (VL)
Video laryngoscopy (VL) uses a camera at the distal end of the
blade to visualize the glottis without requiring a direct line
of sight. Unlike direct laryngoscopy (DL), which depends on
aligning the oral, pharyngeal, and tracheal axes, VL allows
operators to view the airway on a monitor while navigating
around the natural curvature of the upper airway.
Why VL Improves Visualization
- Provides a view from behind the tongue without needing to
align airway axes.
- Reduces the need for aggressive tongue displacement.
- Improves glottic visualization, especially in difficult
airway anatomy.
- Allows multiple team members to see the airway
simultaneously for coaching and supervision.
Most helpful for: novice
clinicians and patients with difficult airways (e.g., cervical
spine immobilization, macroglossia, micrognathia).
Evidence Summary
- VL generally provides better laryngeal views
than DL.
- Some studies show improved first-attempt success, especially
for trainees.
- Time to intubation varies across studies; benefits may be
less pronounced for highly experienced DL operators.
- VL advantages may be underestimated in real-world emergency
settings where airway assessment is limited.
VL Devices
Common Pediatric Videolaryngoscopes
Several VL devices are available for pediatric use, differing
in blade geometry, cost, reusability, and technique. Only a few
systems offer blades sized for the full pediatric age range from
neonates through adolescents.
Key Devices
| Device |
Eligible Ages |
Unique Features |
Tips for Use |
| Airtraq |
Neonate–Adult |
Optical system; optional video
camera; disposable single-use; channeled blade;
color-coded to Broselow. |
Begin looking through viewfinder
early; if ETT catches below posterior cartilages, lift
device upward rather than rocking back. |
| Storz C-MAC |
Neonate–Large Adult |
Miller and Macintosh blades; can
be used for DL or VL; disposable blades available;
hyperangulated “D” blades in pediatric sizes. |
Avoid placing blade too close to
glottis—improves view but worsens tube delivery;
supervisor can guide using screen view. |
| GlideScope |
Neonate–Large Adult |
Hyperangulated blade (60°);
reusable and disposable options; full pediatric size
range; excellent for anterior airways. |
Use rigid stylet; insert
shallowly for broader view; partially withdraw stylet
after passing cords; look into mouth during insertion to
avoid trauma. |
| King Vision |
Neonate–Large Adult |
Disposable blades; size 1
unchanneled for infants; size 2–3 channeled or
unchanneled; lower cost than C-MAC/GlideScope. |
With channeled blades, lift
device upward (not backward) if ETT catches below
posterior cartilages. |
| Truview EVO2 |
Neonate–Large Adult |
Optical system; optional video
monitor; continuous oxygen delivery; refracted view
enlarges field. |
Oxygen insufflation delays
desaturation; midline insertion; may require gentle
lifting of tongue and soft tissue. |
| McGrath Series 5 |
School Age–Adult |
Portable, self-contained;
disposable blades; adjustable blade length. |
Midline approach; tip sits in
vallecula; bougie or ELM may assist with tube delivery. |
| Pentax-AWS |
Adolescents–Adults |
Channeled blade; single-use;
crosshair targeting; optional oxygen or suction channel. |
Pass blade under epiglottis;
preloading ETT with bougie or using ELM may improve
success. |
Clinical pearl: VL is
increasingly used as a first-line device in pediatric emergency
airways, especially for trainees and anticipated difficult
airways.
RSI Preparation
Preoxygenation
Because children desaturate rapidly during apnea, maximizing
preoxygenation is essential before intubation. Traditional
preoxygenation in the ED uses a nonrebreather mask (NRB), often
supplemented with nasal cannula oxygen. While “flush rate”
oxygen (>15 L/min) improves NRB performance in adults, its
benefit in small children with lower minute ventilation is less
clear.
Methods of Preoxygenation
- Nonrebreather mask (NRB): Standard
first-line method; may be supplemented with nasal cannula.
- Bag-mask ventilation (BVM): Provides higher
FiO₂; useful when spontaneous ventilation is inadequate.
- Apneic oxygenation: Nasal cannula left in
place during laryngoscopy to prolong safe apnea time. Evidence
in children is limited but widely used in PEM practice.
Suggested Nasal Cannula Flow Rates for Apneic Oxygenation
- Infants: 2–5 L/min
- School-age children: 5–15 L/min
- Adolescents: ≥15 L/min
Clinical pearl: Higher
flows have been safely used in fasted OR patients; risk of harm
is low when cannula size does not occlude the nares.
RSI Preparation
Patient Positioning
Intubation and BVM ventilation are traditionally performed
with the patient supine. However, positioning can significantly
influence airway patency, visualization, and ventilation.
Key Positioning Strategies
- Head-elevated (“ramped”) position:
Elevates torso and head to align airway axes; improves glottic
view and intubation success in adult studies, with emerging
pediatric support.
- Sniffing position: Neck flexion with head
extension; standard for DL and VL.
- Upright or prone positioning: May improve
airway patency for BVM in select cases.
Clinical pearl:
Head-elevated positioning may reduce airway obstruction and
improve first-pass success—an evolving best practice in
pediatrics.
RSI Medications
Sedatives
RSI sedatives should produce rapid unconsciousness with
minimal hemodynamic or intracranial pressure effects. No agent
is ideal for all situations; selection depends on the child’s
physiology and clinical context.
Common RSI Sedatives
| Medication |
Dose |
| Benzodiazepines (midazolam,
lorazepam) |
0.2–0.3 mg/kg |
| Fentanyl |
1–2 mcg/kg |
| Ketamine |
1–3 mg/kg |
| Etomidate |
0.3 mg/kg |
| Propofol |
1–4 mg/kg |
Ketamine
- Rapid onset; preserves airway reflexes and respiratory
drive.
- Supports blood pressure—useful in hemodynamic instability.
- Adverse effects: vomiting, laryngospasm, emergence delirium.
- Increases secretions; atropine often recommended but onset
is slow (15–20 min).
- Historically avoided in head trauma due to ICP concerns,
but modern evidence shows variable effects and potential
benefit to cerebral perfusion.
- Bronchodilator properties may help in status asthmaticus.
Etomidate
- Rapid onset, predictable pharmacokinetics, cardiovascular
stability.
- No increase in ICP.
- Associated with adrenal suppression; caution in septic
shock per PALS and critical care guidelines.
- Mixed evidence regarding outcomes in trauma and sepsis.
Propofol
- Rapid onset but significant risk of hypotension.
- Generally avoided in hypovolemia, shock, or when cerebral
perfusion must be preserved.
Benzodiazepines
- Provide amnesia and anticonvulsant effects; reversible with
flumazenil.
- Higher doses (0.3–0.4 mg/kg) often required for induction.
- Slower onset and risk of cardiovascular depression at
induction doses.
Critical reminder: Any
sedative can precipitate cardiovascular collapse in unstable
children. In profound shock, very low-dose or no sedative may be
appropriate if the child is already unconscious.
Agents such as dexmedetomidine, remifentanil,
and propofol/remifentanil combinations are being studied but
have limited evidence in pediatric ED RSI.
RSI Medications
Neuromuscular-Blocking Agents (Paralytics)
Paralytics eliminate laryngeal reflexes and muscle tone,
improving intubating conditions. Ideal agents have rapid onset
and short duration, though duration must be balanced with the
need for ongoing paralysis during repeated attempts.
| Medication |
Dose |
| Succinylcholine |
1–2 mg/kg |
| Rocuronium |
0.6–1.2 mg/kg |
| Vecuronium |
0.1–0.2 mg/kg |
| Cisatracurium |
0.1–0.2 mg/kg |
Succinylcholine
- Rapid onset (30–60 sec), short duration (3–8 min).
- Depolarizing agent → fasciculations, myalgias, hyperkalemia
risk.
- Rare risk of malignant hyperthermia.
- Black box warning: hyperkalemic arrest in children with
undiagnosed myopathies.
- May cause bradycardia; atropine sometimes used to mitigate.
Rocuronium
- High-dose (1.2 mg/kg) provides onset similar to
succinylcholine.
- Longer duration (30–45+ min) can be advantageous during
difficult airways.
- Allows continued paralysis for repeated attempts, imaging,
or procedures.
- Reversible with sugammadex if early return of ventilation or
neurologic exam is needed.
Other Nondepolarizing Agents
- Vecuronium: Intermediate onset; longer
duration.
- Cisatracurium: Useful in organ dysfunction;
slower onset.
Critical reminder: After
intubation, ensure ongoing sedation—paralyzed patients cannot
signal distress.
RSI Adjuncts
Adjunctive Agents
Atropine
Atropine reduces the risk of bradycardia associated with
laryngoscopy or succinylcholine use—a phenomenon more common in
infants and young children. It also decreases oral secretions,
which may be helpful when ketamine is used, although its
antisialogogue effect requires 15–20 minutes to take effect and
therefore has limited impact during emergent RSI.
Lidocaine
Lidocaine has historically been used to blunt the autonomic
response to laryngoscopy and reduce intracranial pressure (ICP),
particularly in traumatic brain injury. However, adult
meta-analyses show no clear benefit, and pediatric data are
lacking. Routine use of lidocaine as an RSI adjunct is not
recommended.
Post‑Intubation
Postprocedure Management
Immediately after intubation, correct placement of the
endotracheal tube (ETT) must be confirmed. Esophageal intubation
remains a significant risk, especially in children and
prehospital settings.
Primary Confirmation: End‑Tidal CO₂
- Colorimetric or waveform capnography is
the most rapid and reliable method of confirming tracheal
placement.
- Continuous waveform capnography provides both qualitative
and quantitative confirmation.
Secondary Confirmation
Even when the tube is visualized passing through the cords,
secondary confirmation is required due to the risk of
misidentification, poor visualization, or tube dislodgement.
- Direct or video visualization of ETT passing through the
cords.
- Symmetric chest rise.
- Bilateral breath sounds; absence of gastric insufflation.
- Condensation in the ETT (not reliable alone).
Clinical caution:
Auscultation is often unreliable in noisy resuscitations and may
falsely reassure providers during esophageal intubation.
Pulse Oximetry
Continuous pulse oximetry is essential but should not be
relied upon for early detection of esophageal intubation.
Children may desaturate rapidly, but in some cases there is a
lag before hypoxia develops.
Imaging
- Chest radiograph remains standard of care
for confirming ETT depth and position.
- Point‑of‑care ultrasound (POCUS) can
rapidly identify tracheal placement, assess lung sliding, and
detect mainstem intubation.
Post‑Intubation
Maintenance of Sedation
After intubation, sedation must be promptly re‑established.
Paralytics such as rocuronium often outlast the induction
sedative, leaving the patient paralyzed but awake unless
additional sedation is administered.
- Provide bolus doses or initiate continuous infusions
immediately after confirmation of ETT placement.
- Monitor for signs of inadequate sedation (tachycardia,
hypertension, ventilator dyssynchrony).
- Ensure ongoing analgesia as well as sedation.
Critical reminder:
Paralyzed patients cannot signal distress—sedation must be
proactively maintained.
Rescue Airway
Rescue Devices in Pediatric Airway Management
When to Use Rescue Devices
Rescue devices are used in “can’t intubate, can’t ventilate”
situations when face‑mask ventilation is ineffective. They are
not definitive airways and do not protect against aspiration,
but they can prevent life‑threatening desaturation while
additional help or equipment is mobilized.
Supraglottic Airways (SGAs)
Laryngeal mask airways (LMAs) are the most commonly used SGAs
in both adults and children. They consist of a teardrop‑shaped
cuff that sits in the hypopharynx above the glottis, directing
airflow into the trachea.
Key Features
- Available in sizes suitable for neonates through adults.
- Easy to place with minimal training.
- Low complication rate.
- Some models allow ETT passage through the device
for intubation (“intubating LMAs”).
- Second‑generation SGAs include gastric drainage
channels to reduce insufflation and aspiration
risk.
Evidence: SGAs have
demonstrated comparable or improved outcomes to prehospital
intubation in adult cardiac arrest and neonatal resuscitation.
Other Supraglottic Devices
Esophageal Combination Tube (Combitube)
- Dual‑lumen tube with two cuffs; usually enters the
esophagus.
- Allows ventilation regardless of esophageal or tracheal
placement.
- Available only for patients ≥1.2 m tall → limited pediatric
use.
Laryngeal Tube
- Blindly inserted into the esophagus; dual cuff system seals
the hypopharynx.
- Available in sizes down to 0 for infants <5 kg.
- Increasingly used in prehospital settings.
Perilaryngeal Airway
- Inflatable cuff with widened distal end designed to sit
behind the larynx.
- Comparable ease and speed of placement to LMAs in pediatric
trials.
- Can accommodate bronchoscopy or intubation through the
device.