Adverse Events Associated with Airway Management in Pediatric Anesthesia: A Prospective, Multicenter, Observational Japan Pediatric Difficult Airway in Anesthesia (J-PEDIA) Study

BACKGROUND: The incidence of adverse events and desaturation during airway-securing procedures (a sequence from preoxygenation to completion of tracheal intubation or supraglottic airway placement) under general anesthesia in children remains underexplored. Thus, this study investigated the incidence of adverse and desaturation events and associated risk factors. METHODS: This was a prospective, multicenter, observational study conducted between June 2022 and January 2024 in 10 tertiary care (6 pediatric and 4 university [mixed adult-pediatric]) hospitals in Japan. A standardized data collection system was applied through the recruited institutions to collect 95% or more of cases. The primary and secondary outcomes were adverse events and a 10% or greater drop in oxygen saturation (desaturation) associated with airway-securing procedures. RESULTS: There were 17,007 airway management procedures in 16,695 children (mean ± SD age, 6.3 ± 4.8 yr). Any adverse events occurred in 346 of 17,007 (2.0%; 95% CI, 1.8 to 2.3) children, including 189 of 17,007 (1.1%; 0.96 to 1.3) respiratory adverse events. Desaturation occurred during 395 of 17,007 (2.3%; 2.1 to 2.6) procedures, with 66 of 308 (21.4%; 17.0 to 26.4) in neonates and 210 of 2,298 (9.1%; 8.0 to 10.4) in infants. Multilevel regression analysis showed younger age (adjusted odds ratio, 0.92; 95% CI, 0.90 to 0.95; P < 0.001), airway management in radiation diagnostic/therapy rooms (5.7, 1.64 to 19.9; P = 0.006), airway sensitivity (1.46, 1.09 to 1.94; P = 0.010), craniocervical surgery (1.41, 1.09 to 1.83; P = 0.009), and presence of one anatomical difficult airway feature (1.74, 1.02 to 2.95; P = 0.042) versus two or more anatomic difficult airway features (2.82, 1.21 to 6.6; P = 0.017) as risk factors of any adverse events. Supraglottic airway device usage at the first attempt (0.42, 0.288 to 0.62; P < 0.001) and muscle relaxant administration (0.62, 0.43 to 0.89; P = 0.009) showed beneficial effects. CONCLUSION: s: The Japan Pediatric Difficult Airway in Anesthesia (J-PEDIA) study demonstrated adverse event and desaturation incidences and the impact of clinically relevant risk factors during airway-securing procedures in Asian children. This study can help anesthesiologists to identify high-risk children and create a safe airway-securing strategy.