The 3 Golden Rules of difficult airways: 1. Prepare as if every airway could be difficult. 2. Know that a thorough airway assessment can predict a potentially difficult airway. 3. Have a go-to plan and a couple of backup plans to manage difficult airways.
"Some airway difficulties can be anticipated and some can not," says Mike Morel, CRNA, of Martin (Tenn.) Anesthesia Group. "Always have Plans B and C ready."
That means keeping your airway cart well-stocked with rescue tools. "Have multiple back-up options immediately available, so if one thing doesn't work there is another quickly available," says Jeff Cryder, CRNA, of Scott & White Hospital in Temple, Texas. It's a good idea to laminate and tether to the cart the ASA's Difficult Airway Algorithm (tinyurl.com/lwhjddp) and a list of the cart's contents.
At the UAB Callahan Eye Hospital in Birmingham, Ala., the airway cart holds a long list of difficult airway equipment, including a variety of LMAs, laryngoscope blades, fiber-optic scopes, a bougie for endotracheal intubation, video-assisted laryngoscopes and Ambu bags with a well-fitting mask and PEEP (positive end expiratory pressure) valves, says chief CRNA Carol Craig.
At the ProMedica Wildwood Orthopaedic & Spine Hospital in Toledo, Ohio, the airway cart has supplies such as a handheld portable video laryngoscope, fiber-optic scope, a video laryngoscope and all necessary supplies available in the sterile core as well as routine airway supplies located in each OR, says Kendra Ondrus, CRNA, MA.
It's not enough to simply have the rescue tools on hand. Have trained personnel who know how to use this equipment experienced CRNAs and anesthesiologists who can recognize the early signs of an emergency and have the available tools to handle the situation, several providers say.
Anesthesiologist Amber Jandik, MD, of Lee Memorial Outpatient Surgery Center in Fort Myers, Fla., adds that when a difficult airway strikes, there's no time to waste hunting down needed tools and supplies. "Have several sizes of LMAs available in each procedure room. Keep your [video laryngoscope] fully charged and easily accessible. Be sure each staff member knows what it is, where it is, and that when you ask for it, they are to bring it to you in a hurry."