Management of the difficult airway

Abstract

© Cambridge University Press 2011. Management of a difficult airway is one of the more challenging tasks for an anesthesiologist. It necessitates dexterity with various airway devices and techniques as well as the ability to adapt rapidly to complex and evolving situations involving diverse patient factors and clinical scenarios. Competency in dealing with a difficult airway is expected of all anesthesiologists and is of critical importance, for it can have a profound impact on patient outcome (death, brain injury, cardiopulmonary arrest, unnecessary tracheostomy, and airway trauma). The American Society of Anesthesiologists (ASA) Closed Claims Project database demonstrates that difficult intubation is the second most frequent primary damaging event leading to anesthesia malpractice claims. Definition In 2003, the ASA Task Force on Management of the Difficult Airway published an updated report that defined the difficult airway as “the clinical situation in which a conventionally trained anesthesiologist experiences difficulty with face mask ventilation of the upper airway, difficulty with tracheal intubation, or both.” This publication includes a revised difficult airway algorithm (DAA), which is a simple yet invaluable tool to guide the practitioner in these situations (Fig. 18.1). As stated in Current Anaesthesia and Critical Care journal, an alternative and often-used definition of a difficult airway is a “an intubation requiring more than three attempts at laryngoscopy or taking longer than ten minutes.”.