In their retrospective study comparing the outcome of difficult airway management in pediatric patients managed with general anesthesia and sedation, Sequero-Ramos et al.1 found little difference in first intubation attempt success or complications between the two groups. It is noteworthy, however, that 27% of the sedation cohort required conversion to general anesthesia. Why was sedation so unsuccessful in the cohort studied? The details of the sedation techniques were not reported, but these results suggest that some of the sedation techniques may be insufficiently refined to achieve the goal of spontaneous ventilation and compliance with airway management. Additional research is needed to understand whether a greater success rate can be achieved using sedation in the pediatric population.
As we seek to investigate sedation techniques for pediatric patients with difficult airways, selection of pharmacologic agents and how they are combined and administered will be an important focus. The human resources available...
