The severe acute respiratory syndrome coronavirus 2 (COVID-19) pandemic has challenged medical systems and clinicians globally to unforeseen levels. COVID-19’s rapid spread has forced clinicians to care for patients with a highly contagious disease without evidence-based guidelines.

Using a virtual modified nominal group technique, the Pediatric Difficult Intubation Collaborative (PeDI-C), which currently includes 35 hospitals from six countries, generated consensus guidelines on airway management in pediatric anesthesia based on expert opinion and early data about the disease.

The PeDI-C identified overarching goals during care, including minimizing aerosolized respiratory secretions, minimizing the number of clinicians in contact with a patient, and recognizing that undiagnosed asymptomatic patients may shed the virus and infect healthcare workers.

Recommendations include administering anxiolytic medications, intravenous anesthetic inductions, tracheal intubation using video laryngoscopes and cuffed tracheal tubes, use of in-line suction catheters, and modifying workflow to recover patients from anesthesia in the operating room.

Importantly, the PeDI-C recommends that anesthesiologists consider using appropriate personal protective equipment when performing aerosol-generating medical procedures in asymptomatic children, in addition to known or suspected children with COVID-19.

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