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91]

Guidelines 3
(AIDAA)
All India Difficult Airway Association 2016 guidelines
for the management of unanticipated difficult
tracheal intubation in Paediatrics

Address for correspondence: Dilip K Pawar, Jeson Rajan Doctor1, Ubaradka S Raveendra 2,
Dr. Jeson Rajan Doctor,
Department of
Singaravelu Ramesh 3, Sumalatha Radhakrishna Shetty 2,
Anaesthesiology, Jigeeshu Vasishtha Divatia1, Sheila Nainan Myatra1, Amit Shah 4,5, Rakesh Garg 6,
Critical Care and Pain, Pankaj Kundra7, Apeksh Patwa 4,5, Syed Moied Ahmed 8, Sabyasachi Das 9,
Tata Memorial Hospital,
Venkateswaran Ramkumar10
Dr. Ernest Borges Road,
Department of Anaesthesiology, All India Institute of Medical Sciences, New Delhi, 1Department of
Parel, Mumbai ‑ 400 012,
Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Mumbai, Maharashtra, 2Department
Maharashtra, India.
of Anaesthesiology and Critical Care, K. S. Hegde Medical Academy, Nitte University, Mangalore,
E‑mail: jesonrdoctor@ 3
Chief Consultant Anaesthesiologist, Kanchi Kamakoti CHILDS Trust Hospital, Chennai, Tamil Nadu,
gmail.com 4
Consultant Anaesthesiologist, Kailash Cancer Hospital and Research Centre, 5Consultant Anaesthesiologist,
Vadodara Institute of Neurological Sciences, Vadodara, Gujarat, 6Department of Onco‑Anaesthesiology
and Palliative Medicine, Dr. BRAIRCH, All India Institute of Medical Sciences, New Delhi, 7Department
of Anaesthesiology and Critical Care, JIPMER, Puducherry, 8Department of Anaesthesiology and Critical
Care, J N Medical College and Hospital, AMU, Aligarh, Uttar Pradesh, 9Department of Anaesthesiology,
North Bengal Medical College, Darjeeling, West Bengal, 10Department of Anaesthesiology, Kasturba Medical
College, Manipal, Karnataka, India

ABSTRACT

The All India Difficult Airway Association guidelines for the management of the unanticipated
difficult tracheal intubation in paediatrics are developed to provide a structured, stepwise approach
to manage unanticipated difficulty during tracheal intubation in children between 1 and 12 years
of age. The incidence of unanticipated difficult airway in normal children is relatively rare. The
Access this article online recommendations for the management of difficult airway in children are mostly derived from
Website: www.ijaweb.org extrapolation of adult data because of non‑availability of proven evidence on the management
of difficult airway in children. Children have a narrow margin of safety and mismanagement of
DOI: 10.4103/0019-5049.195483
the difficult airway can lead to disastrous consequences. In our country, a systematic approach
Quick response code
to airway management in children is lacking, thus having a guideline would be beneficial. This is
a sincere effort to protocolise airway management in children, using the best available evidence
and consensus opinion put together to make airway management for children as safe as possible
in our country.

Key words: Paediatric airway, paediatric guidelines, unanticipated difficult intubation

INTRODUCTION paediatric airway are more serious and could lead

to increased incidence of morbidity and mortality.[3,4]
A majority of children with difficult airways can be
identified during pre‑anaesthetic assessment. The This is an open access article distributed under the terms of the Creative
Commons Attribution‑NonCommercial‑ShareAlike 3.0 License, which allows
reported incidence of difficult intubation in infants is others to remix, tweak, and build upon the work non‑commercially, as long as the
0.24%–4.7% and 0.07%–0.7% in older children.[1,2] author is credited and the new creations are licensed under the identical terms.

For reprints contact: [email protected]

In view of insufficient data and lack of evidence,
recommendations for the management of difficult How to cite this article: Pawar DK, Doctor JR, Raveendra US,
Ramesh S, Shetty SR, Divatia JV, et al. All India Difficult Airway
airway in children are mostly derived from Association 2016 guidelines for the management of unanticipated
extrapolation of adult data. However, compared difficult tracheal intubation in Paediatrics. Indian J Anaesth
to adults, the consequences of mismanagement of 2016;60:906-14.

906 © 2016 Indian Journal of Anaesthesia | Published by Wolters Kluwer - Medknow

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Pawar, et al.: Unanticipated difficult tracheal intubation in paediatrics

This is probably because of narrow margin of safety and jaw thrust during mask ventilation while
resulting from the unique anatomical features of the ensuring that soft tissue is not being pushed by
paediatric airway, as well as physiological differences the fingers holding the mask.[3] In addition, care
such as high oxygen consumption and reduced should be taken not to inadvertently compress
functional residual capacity.[4] the external nares while holding the face mask
• Head is maintained in neutral position for children
In India, a large number of children are anaesthetised and use of a shoulder roll is recommended in
by anaesthesiologists without specialised training in children  <6 months.[3,6] Lateral position should
paediatric anaesthesia. The All India Difficult Airway be considered in the presence of adenotonsillar
Association, (AIDAA), therefore decided to have hypertrophy or lingual tonsil or when mask
guidelines to facilitate difficult airway management ventilation is not improved by other techniques
in children. These guidelines will be useful for both described here in supine position.[7] Airway
specialist paediatric anaesthesiologists as well the adjuncts such as correct sizes of oropharyngeal
anaesthesiologists who occasionally anaesthetise and nasopharyngeal airways may be helpful
paediatric patients. These guidelines should be • Ventilation with two‑person bag‑mask
used in conjunction with “All India Difficult Airway technique should be considered when face
Association 2016 Guidelines for the Management mask ventilation is difficult. This is particularly
of Unanticipated Difficult Tracheal Intubation in useful in children who are obese, syndromic
Adults”.[5] and have micrognathia
• Laryngospasm should be ruled out whenever
METHODS there is failure during mask ventilation.
Laryngospasm is a common cause of difficult
The methodology adopted for the development of mask ventilation in children, unlike adults.
AIDAA guidelines including unanticipated difficult Noxious stimuli at inadequate depth of
tracheal intubation in paediatrics has been explained anaesthesia, hyperactive airway due to upper
in detail in the section on AIDAA guidelines for respiratory tract infections and secretions
unanticipated difficult intubation in Adults.[5] A are common causes of laryngospasm.[8]
thorough literature search was done using databases/ Initial management is with administration of
search engine (Medline, PubMed, Google Scholar and continuous positive airway pressure ventilation,
websites of National Societies for airway guidelines) 100% oxygen and increasing the depth of
till September 2016. The articles were manually anaesthesia with IV propofol.[9,10] If laryngospasm
searched from cross referencing. All manuscripts is not relieved and/or desaturation ensues IV
and abstracts published in English were searched. suxamethonium is the drug of choice
The key words used included ‘unanticipated • Gastric distension is a sequel of improper face
difficult intubation’, ‘difficult airway’, ‘difficult mask mask ventilation and should be managed by
ventilation’, ‘supraglottic airway’, ‘cricothyroidotomy’, insertion of an oro/nasogastric tube. Whenever
‘paediatric tracheostomy’, ‘transtracheal puncture’ and there is a rise in peak airway pressure, gastric
‘high pressure jet ventilation’. Furthermore, opinions distension occurs resulting in further difficulty
of experts and members of the societies were taken in mask ventilation due to splinting of the
for paediatric‑related concerns not having definite diaphragm[6]
evidence. • Administration of a neuromuscular blocker can
be considered if not already paralysed. However,
UNANTICIPATED DIFFICULT FACE MASK VENTILATION this decision should be taken by a qualified and
experienced anaesthesiologist based on sound
When there is unanticipated difficulty in spite of clinical judgement.
appropriate equipment, following aspects should be
considered: OPTIMISING LARYNGOSCOPY AND TRACHEAL
• Adequate depth of anaesthesia. This can be INTUBATION
achieved with intravenous (IV) anaesthetics
such as propofol for faster action or with Equipment
inhalational agents Children below 12 years require specialised airway
• Upper airway is kept patent with chin lift equipment appropriate to their age and weight. In the

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Pawar, et al.: Unanticipated difficult tracheal intubation in paediatrics

absence of these, it is safer not to attempt management commissure, a slightly rotating movement of the tube
of a paediatric difficult airway. The equipment should will often solve the problem. As soon as the ETT is in
include all the correct sizes of equipment mentioned place, the centimetre marking near the gingiva or teeth
in the difficult airway cart. is noticed. This makes it possible to re‑establish the
position of the tube, if it is accidentally moved during
Prerequisites fixation.
• Before laryngoscopy, an IV access must be
secured Videolaryngoscopes
• Appropriate monitoring in the form of Videolaryngoscopy has been described in
electrocardiogram, pulse oximeter, non‑invasive paediatric patients with channelled (Airtraq ) and
®

blood pressure and capnography should be non‑channelled (C‑MAC®, Glidescope® and Truview®)
available videolaryngoscopes.[12,13]
• Pre‑oxygenation with 100% oxygen
• Adequate depth of anaesthesia, analgesia With videolaryngoscopy, four steps are
and neuromuscular blockade is essential for recommended: (1) insert the video laryngoscope
successful and smooth laryngoscopy and help in under direct vision looking at the mouth, (2) position
obtaining the best view during laryngoscopy[11] it properly looking at the monitor, (3) pass the ETT
• Nasal oxygen to be administered with nasal looking directly into the mouth and (4) pass the ETT
prongs/catheter during attempts at laryngoscopy into the trachea looking at the monitor.
and intubation for apnoea ventilation.
Bimanual laryngoscopy
Laryngoscope type and laryngoscopic techniques In some children, external manipulation with the
For direct laryngoscopy, a Miller or Macintosh type fingers of hand performing laryngoscopy can be
blade can be used for the first attempt. With the Miller inefficient to provide optimal ELM. In such situations,
type straight blade, the epiglottis is lifted directly. the other hand can be used to manipulate the larynx
The Macintosh blade is preferred in older children. with external pressure while a second anaesthesiologist
Alternately, a videolaryngoscope can be used if passes the ETT. Despite these techniques, if epiglottis
equipment and expertise are available. is the only visible structure, then bougie, fibre‑optic
intubation or videolaryngoscopes may be considered.[3]
Positioning
The head, especially the occiput, is relatively large, Use of intubation aids
and this is more pronounced in younger children. Intubation aids can be malleable stylets and soft tip
Optimal position is obtained when the neck is in a introducers with or without a hollow passage. For
neutral position or slightly extended. In neonates example, Gum Elastic Bougie®, Aintree Intubation
and infants, a roll under the shoulders helps to avoid Catheter® and Frova Introducer® (5Fr 50 cm bougie for
flexion of the neck during laryngoscopy.[3,6] neonates and infants, 8 Fr bougie/Frova for children up
to 5–6 years of age (ETT size 5 mm ID) and 11 Fr bougie
External laryngeal manipulation for children over 6 years of age (ETT size 5.5 mm ID).[14]
Because of the long epiglottis and the cephalad location Intubation aids should never be blindly introduced
of larynx, it is always necessary to apply external into the trachea as such practices could result in
pressure on the neck to obtain a good view of the severe airway trauma.[6,15]
laryngeal inlet. External laryngeal manipulation (ELM)
in children can be applied by the anaesthesiologist Number of attempts
doing the laryngoscopy using the little finger or little A maximum of two attempts at laryngoscopy should
and ring fingers of the hand holding the laryngoscope.[3] be allowed in children (this recommendation is
based on consensus). The rationale of limiting the
Technique of intubation attempts is to avoid trauma and hypoxia. Intermittent
When the vocal cords are visualised, the endotracheal face mask ventilation with 100% oxygen should be
tube (ETT) is gently inserted between them and moved performed between attempts to maintain oxygenation.
down through the cricoid cartilage up to mid‑trachea. Nasal oxygen insufflation during apnoea should be
In infants, the vocal cords are angled more anteriorly, continued. Call for help, following the failed first
and if the tip of the tube is caught in the anterior attempt at laryngoscopy. The second attempt should

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Pawar, et al.: Unanticipated difficult tracheal intubation in paediatrics

be attempted only after additional help is available or endotracheal intubation through SAD is not
and oxygen saturation is 95% or higher. A  third and possible and it is a non‑emergency surgery,
final attempt at laryngoscopy should only be done by option of waking up the child should be
an anaesthesiologist with paediatric experience. This considered
should be exploratory to understand the anatomy and • A tracheostomy may be considered only in case
plan a strategy. For second and subsequent attempt, of emergency surgical procedure.
a change in operator, equipment or position or a
combination of these must be considered. All attempts If two attempts to use SAD are not successful, rescue
should be performed with adequate oxygenation and mask ventilation should be resumed.
depth of anaesthesia, optimal equipment, optimal
positioning, ELM and help. EMERGENCY SURGICAL AIRWAY ACCESS

Role of nasal apnoeic oxygenation during intubation The incidence of cannot intubate, cannot oxygenate
Continuing apnoeic oxygenation with passive oxygen or complete ventilation failure situation in children
flow using nasal prongs/catheter during attempts at is extremely rare. Little evidence exists in children
laryngoscopy and intubation is strongly recommended. for the selection of optimal rescue technique. The
This may require another oxygen source with a flow unique anatomy and cephalad position of the infant’s
meter. The flow rate of oxygen should be adjusted larynx, the small size of the cricothyroid membrane,
targeting oxygen saturation more than 95%. adipose tissue in the neck and the technical difficulty
of locating the correct anatomical structures make
Confirmation of successful intubation most of the emergency surgical airway access
Successful tracheal intubation is confirmed by the techniques impractical and dangerous in small
presence of six consistent capnograph traces without children.[18]
any decline in detected levels of carbon dioxide. Other
methods such as 5‑point auscultation and bilateral We recommend to proceed for emergency surgical
chest expansion, condensation of vapour in the ETT airway access whenever there is complete ventilation
during exhalation though less specific, may also be failure, and this is best done while oxygenation is
used to rule out oesophageal intubation.[16] best maintained and one should not wait for a fall
in saturation. The decision to perform an emergency
ROLE OF SUPRAGLOTTIC AIRWAY DEVICE AS A surgical airway access should not be delayed until the
RESCUE DEVICE DURING A DIFFICULT AIRWAY child begins to desaturate.

Supraglottic airway devices (SADs) with a gastric The cricothyroid membrane has a mean vertical
drainage tube (second generation SAD) are preferred.[17] dimension of 2.6 mm (standard deviation [SD],
They fit the airway contour better, have a higher seal 0.7) and width of 3 mm (SD, 0.6) in neonatal
pressure and a gastric drain tube. Number of attempts cadavers (mean height of 44.9 cm and a mean
at SAD insertion should be limited to two. Mask weight of 2 kg) as compared to adults where the
ventilation should be resumed between two attempts. dimensions vary from 8 to 19 mm (mean 13.7 mm) in
If the first attempt to insert SAD fails, consider the vertical dimension and from 9 to 19 mm (mean
changing the size and type of SAD before proceeding 12.4 mm) in the transverse dimension.[19,20] These
to second attempt.[6] anatomical variations lead to difficulty in location
and demarcation of cricothyroid membrane. The
If SAD is successfully placed, cricothyroid membrane is angulated in newborn
• It is to be decided if it is safe and essential to up to 60°–70° to tracheal axis as compared to adults
proceed with the procedure, with the SAD as where it is almost parallel.[21] Probably, it reaches
the primary ventilation device the adult structure around the age of 5 or 6 years.
• If endotracheal intubation is required to proceed Hence, when punctured with a needle, the tip
with surgery, one should consider passing ETT might be directed towards the laryngeal inlet and
through the SAD using a flexible fibre‑optic hypopharynx in children.[21]
bronchoscope, only if equipment and expertise
are available The options for emergency surgical airway access with
• If it is unsafe to proceed with a SAD in place available evidence in children include:

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For children <8 years of age otherwise, it can lead to barotrauma and pneumothorax.

Tracheostomy The diameter of the small bore cannula may not be
In children below 8 years of age, surgical tracheostomy enough for adequate expiration to occur. Oxygen must
is the procedure of choice when skilled surgical help be continued through the upper airway.
is available. Johansen et al. and Stacey et al. have
mentioned that cricothyroidotomy can be dangerous Adequate time for expiration
in children and a surgical tracheostomy is the method The I: E ratio should be maintained at 1:4, so there
of choice.[22‑24] During tracheostomy, attempt should be is enough time for expiration to take place, thereby
made to maintain oxygenation by keeping the upper preventing barotrauma.
airway patent and continuously administering 100%
oxygen. Other methods of oxygenation
Other methods of oxygenation such as Enk Oxygen
However, if trained surgical help for a surgical Flow Modulator®, Ventrain® and Rapid O2® are
tracheostomy is not available, then it is recommended recommended for adults; however, its availability is
to proceed with a transtracheal needle puncture/needle limited for paediatric patients. The use of a three‑way
cricothyroidotomy  (with a needle  <4 mm diameter) technique for oxygenation (with intermittent finger
and jet ventilation with a pressure regulated jet occlusion of the three‑way port) is strictly not
ventilation device.[18] recommended in children anymore.[14]

Transtracheal needle puncture/needle Cricothyroidotomy cannula kinking and dislodgement

cricothyroidotomy should be avoided as it can lead to subcutaneous
The best strategy for emergency transtracheal needle emphysema.[6]
puncture/cricothyroidotomy and oxygenation in
children under 12 years of age remains unclear. In Wide bore cannula cricothyroidotomy
young children, especially infants and neonates, the Most of the cannula cricothyroidotomy sets used in
cricothyroid membrane is small and difficult to localise, adults are contraindicated in children as the diameters
often lying immediately under the mandible, making of these devices are more than 4 mm. If used, these
it a less than ideal site for emergency surgical airway can cause irreversible damage to the child’s airway.
access.[25] Transtracheal needle puncture is, therefore, The APA guidelines recommend that cannulae with
commonly proposed in this age group as opposed to a diameter of more than 4 mm should not be used in
needle cricothyroidotomy.[18] In children of 5–7 years, children <8 years.[6]
a needle cricothyroidotomy may be attempted. Overall,
needle cricothyroidotomy showed a better success Surgical cricothyroidotomy
rate than scalpel bougie cricothyroidotomy.[26] Scalpel The dimensions of the cricothyroid membrane are too
cricothyroidotomy is not recommended below the age small for passing a tracheal tube.[4] The dimensions of
of 12 years. A 16 or 18 G IV cannula is usually used for the tube exceed that of the cricothyroid membrane,
cricothyroidotomy in children as the external diameter and this could fracture the cartilages of the larynx.
is <4 mm, thereby reducing the chances of injury to the The performance of a surgical cricothyroidotomy
cricothyroid membrane or the trachea.[14] The details on and passing of a tracheal tube through it is, therefore,
technique of a needle cricothyroidotomy are discussed strongly discouraged in children <12 years.
in the respective section in All India Difficult Airway
Association 2016 Guidelines for the Management of For children older than 8 years and up to 12 years
Unanticipated Difficult Tracheal Intubation in Adults.[5] For older children between 8 and 12 years of age,
a needle cricothyroidotomy is relatively safer
Pressure regulated jet ventilation devices compared to neonates or smaller children.[27] In
Once the needle is in the trachea, it is advisable to children older than 8 years of age, the vertical
begin with the lowest pressure (0.5 bar) and gradually span of the cricothyroid space enlarges sufficiently
increase the pressure till a visible chest rise and to accommodate several commercially available
improvement in oxygenation is obtained.[6] cricothyroidotomy products. However, some of these
devices have been associated with tracheal damage
Maintaining upper airway patency to aid expiration in animal models and therefore should be cautiously
while using a jet ventilation device is mandatory; used in children.[4]

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Pawar, et al.: Unanticipated difficult tracheal intubation in paediatrics

Cricothyroidotomy should be performed only for Step 2: Maintaining oxygenation using a supraglottic
emergency oxygenation and a definitive airway, for airway device
example, a tracheostomy should be performed or When intubation fails, insert a second generation
secured as soon as possible. A definitive tracheostomy SAD to maintain oxygenation. Maximum two
should be done in <40 min or else dangerous plasma attempts at SAD insertion with mask ventilation
levels of CO2 may build up.[28] using 100% oxygen in between. Consider using an
alternate type of SAD, continue nasal oxygenation
STEPWISE APPROACH TO MANAGEMENT OF and maintain the depth of anaesthesia till SAD is
THE UNANTICIPATED DIFFICULT INTUBATION IN in place. Once SAD has been successfully inserted,
CHILDREN (1–12 YEARS) REFER FIGURE. 1 effective ventilation and oxygenation will be
maintained. This will provide sufficient time to
It is important to remember that while following think about a further airway management plan.
any step in the algorithm, if the oxygen saturation The safest option will be to wake up the child if it
is not maintained or starts falling rapidly or there is is a non‑emergency surgery. If it is an emergency
bradycardia, one can bypass any step and even consider procedure and continuation of the procedure is safe
emergency surgical airway. The below‑mentioned using SAD, one may proceed keeping in mind that
algorithm [Figure 1] is recommended to be used for this is a high‑risk option. One must remember that
children between 1 and 12 years of age. Neonates this patient had a failed intubation and any trauma
and infants have special considerations and are during attempts may produce airway oedema which
recommended to be managed by persons with expertise may worsen during the course of the surgery. If the
in a special setup equipped to manage them. procedure is unsafe to be continued using an SAD
and the procedure is an emergency major surgery, one
Calling for help should consider intubation through the SAD using a
Help should be sought at the earliest when the first flexible fibre‑optic bronchoscope if the expertise is
difficulty in airway management is encountered. While available. In very rare situations, a tracheostomy may
any additional help will be useful during a difficult be necessary despite successful ventilation using the
airway, one should try to get expert help if available. The SAD.
AIDAA recommends calling for additional help when
the final attempt at rescue mask ventilation fails and Step 3: One last attempt at mask ventilation
emergency surgical airway access is planned. When SAD insertion fails, one final attempt at
mask ventilation should be tried after ensuring
Step 1: Mask ventilation and tracheal intubation neuromuscular blockade using the optimal technique
Maximum two attempts at intubation should be for mask ventilation and an oropharyngeal/
performed provided the SpO2 levels are ≥95%. Final nasopharyngeal airway if required. Ensure that the
attempt should be performed by an anaesthesiologist mouth is open and soft tissue is not being pushed by
with paediatric experience. (If unavailable, do not the finger while mask holding. Upper airway should
attempt another laryngoscopy, proceed to Step 2). be kept patent with chin lift and jaw thrust. Ensure
Continue nasal oxygenation during apnoea and complete neuromuscular blockade during the final
maintain depth of anaesthesia throughout. If intubation attempt at mask ventilation before proceeding to
is difficult, one should change the plan in between emergency surgical airway access. Insert an orogastric
attempts to improve the chance of success rather or nasogastric tube to decompress the stomach and
than repeatedly doing the same procedure. This may prevent the splinting of diaphragm. If face mask
involve changing the position, different technique, ventilation is successful, the patient should be woken
intubating device like using a videolaryngoscope, up after reversal of the neuromuscular blockade.
ELM, using additional tools such as bougie or stylet or Continue nasal oxygenation. When there is complete
additional manoeuvres (bimanual laryngoscopy). If a ventilation failure, call for additional help and proceed
Cormack–Lehane grade of 3 or above is encountered, to perform emergency surgical airway access before
one should abandon intubation attempts and continue the patient desaturates.
mask ventilation until a definite airway management
plan is made and experienced help is available. If Step 4: Emergency surgical airway access
attempts at intubation fail, resume mask ventilation Continue nasal oxygen and efforts at rescue face mask
using 100% oxygen. ventilation.

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Pawar, et al.: Unanticipated difficult tracheal intubation in paediatrics

Figure 1: All India Difficult Airway Association 2016 algorithm for the Management of Unanticipated Difficult Tracheal Intubation in Paediatrics

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Pawar, et al.: Unanticipated difficult tracheal intubation in paediatrics

For children <8 years of age, a surgical tracheostomy documentation of the airway difficulty and filling of
is the first choice if skilled surgical help is available. an airway alert must be done.
If skilled help is not available then a transtracheal
needle puncture for children  <5  years or a needle Financial support and sponsorship
cricothyroidotomy for children between 5 and 7 years All expenses related to the development of the
may be performed. To maintain oxygenation through guidelines were entirely funded by the All India
these devices, pressure‑regulated jet ventilation Difficult Airway Association.
is needed. A prerequisite to use jet ventilation is
maintenance of patency of upper airway. Conflicts of interest
There are no conflicts of interest.
For children between 8 and 12 years, perform
emergency surgical airway access using needle REFERENCES
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Best Original Article of The Year

The ISA-IJA Award

Dear Authors / Researchers!!

Greetings from IJA!

Your publication could become the best in the business for the year!

The Indian Journal of Anaesthesia (IJA) will choose three best original articles

published in IJA, each year, to promote the spirit of research and publications.

 Eligibility: Best anaesthesia, critical care and pain related original articles
published between October previous year to September of Current year

 The publications are assessed as per the guidelines of the IJA, ICMJE and
Consolidated Standards of Reporting Trials (CONSORT)

 For greater chances of winning, please update yourself before submitting

articles at
http://www.ijaweb.org, www.ijaweb.in
http://www.icmje.org
http://www.consort-statement.org

A team of editorial board would decide on the winner! The certifcate will be
presented during IJA sesssion during ISACON in November each year.

S Bala Bhaskar

Editor In Chief

914 Indian Journal of Anaesthesia | Vol. 60 | Issue 12 | Dec 2016

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