No aspect of the practice of pediatric anesthesia is more essential than airway management. Pediatric anesthesiologists are the ‘go to’ specialists when infants and children with difficult airways present anywhere in the hospital. To our advantage, rapid technical advances have taken place during the past decades and the number of tools available to assist us in providing and maintaining a secure and stable airway has increased significantly. Until the 1970s tracheal intubation with a conventional laryngoscope or blind nasal intubation were the mainstays of establishing an artificial airway. The choice of endotracheal tubes was limited. During the past 20 years a remarkable assortment of equipment and novel techniques to facilitate optimal airway management have been developed. These include supraglottic airways, direct and fiberoptic laryngoscopes and transtracheal devices. Improved imaging of the airway prior to initiation of airway management, with CT and MRI, for example, and during airway manipulation and instrumentation, using fiberoptic cameras and portable video displays, is now widely used. While new developments in airway management have helped us improve the quality of care of our patients, new challenges have also arisen. Which techniques should we learn, teach and employ? Which endotracheal tubes should be utilized – uncuffed or cuffed, old or new design? Which of our patients need preoperative imaging of the airway and/or sleep studies? What are the risks of newer interventions, including novel airway devices and laser instruments
