Incidence and factors responsible for multiple attempts at laryngoscopy in children

Paediatric airway management has always posed a greater challenge, for anesthesiologists, in contrast to adults. Although most children with difficult airways are recognised before induction of anesthesia but still chances of airway related adverse events is more in younger population. Reasons for this lies in the fact that pediatric respiratory physiology is different from that of adult. They have low physiologic reserve, Oxygen consumption is higher, have lower functional residual capacity and their airway is more reactive. A small amount of narrowing (due to oedema, inflammation, etc.,) in the already small pediatric airway have severe consequences on respiratory function. Increase in number of laryngoscopy attempts cause increased airway manipulation, and longer discontinuation of oxygenation, leading to laryngospasm, desaturation, bradycardia, Airway oedema, airway trauma, aspiration, hypoxemia, hypotension, dysrhythmia and cardiac arrest. Thoughtful attention to recognition of factors which may contribute to increase in laryngoscopy attempts may help in maximizing the chance for first attempt success. The incidence of multiple attempts and various factors responsible for it are not properly defined in patient population presenting to our institute. Identification of various factors will help to reduce the risk of adverse events associated with multiple laryngoscopy attempts. The number of laryngoscopy attempts matter!!