Airway-related problems are the most common critical incidents in paediatric anaesthesia and are four times more common in infants than in older children. This chapter discusses anatomical and physiological differences in the paediatric airway. Straight laryngoscope blades are useful in infants up to about the age of 3 to 6 months. In contrast to the tracheal tube (TT), paediatric laryngeal mask airways (LMAs) are sized according to patient weight. There are a number of syndromes and pathologies that are known to be associated with difficult airway management. There are a number of causes, both congenital and acquired, of airway obstruction in the child. The general principles of airway management are the same regardless of underlying cause, however, there are two scenarios that deserve special attention: inhalation of a foreign body, and acute epiglottitis. Rapid sequence induction is not a standard in paediatric practice.

Cross-infection may occur through reusable airway devices. The infective agent for transmissable spongiform encephalopathies (TSE) transmission is an abnormal prion protein. No prion-specific nucleic acid is involved in disease transmission, and abnormal prion-protein infectivity is not controlled by standard decontamination procedures of standard autoclaving or cold chemical sterilisation. A guideline on infection control within anaesthesia was published by the Association of Anaesthetists of Great Britain and Ireland (AAGBI) in 2008 and provides valuable advice. There are three possible options for airway equipment, single use equipment, steam sterilisation or cold chemical sterilisation. Single use equipment eliminates the risk of cross-infection between patients through the airway device and is the preferred option. Repeated cycles of heat sterilisation will produce loss of transmitted light in rigid laryngoscope bundles. Cold chemical sterilisation is appropriate for devices which are not single use and are thermally sensitive. Automated disinfectors should be used for fibrescopes.