A physician performing endotracheal intubation on a 7-year-old is unable to visualize laryngeal structures. The neonatal/pediatric specialist should

• A. Suggest the tip of the laryngoscope below the vallecula
• B. Administer cricoid pressure
• C. Suction the upper airway
• D. Administer a topical anesthetic

Answer: (B)

When you can’t visualize the laryngeal inlet during intubation, the immediate priority is to protect the airway from aspiration while you pursue another plan to secure ventilation. Applying cricoid pressure (the Sellick maneuver) compresses the esophagus against the vertebral column, aiming to minimize the risk of regurgitation and aspiration in a patient under anesthesia when protective airway reflexes are diminished. This creates a safer window to reassess and proceed with alternative approaches, such as repositioning, using a video laryngoscope or bougie, or placing a supraglottic airway as a bridge while you attempt another intubation attempt.

Do this with careful, firm but controlled pressure on the cricoid cartilage, and be prepared to release briefly if ventilation becomes impeded or if you need to reassess the airway. The other options don’t address the immediate risk of aspiration or airway protection in this scenario: altering blade placement without improving visualization, suctioning alone, or using topical anesthetic does not tackle the essential goal of preventing aspiration while securing the airway.