Archive Anesthesia 2018

Are You Ready to Handle Difficult Airways?

Have a plan in place and needed tools on hand to solve challenging intubations.

Carin Hagberg

Carin Hagberg, MD


duly noted
LINE OF SIGHT Video laryngoscopes provide direct views of the glottis, even in patients with challenging airway anatomy.
It's easy to anticipate intubation troubles when wheeling an obese patient with a thick neck into the OR, but physical appearance is never a guarantee of how hard an airway will be to manage. Many difficult airways are unexpected, so it's best to plan and prepare as if every patient's airway will fail. Ask yourself these 5 questions to determine if your surgical team is ready to stay calm and intubate when airway management goes from routine to risky.

1. Do you conduct pre-op airway exams?

Your anesthesia providers should conduct a pre-op evaluation of the patient's airway before each case. Although physical characteristics aren't always associated with intraoperative airway trouble, there are red flags that can be identified during exams, including relatively long upper incisors, a prominent overbite, a short, a thick neck and the inability to visualize the uvula when the patient's tongue is protruded.

2. Do you have a plan in place?

There are 5 categories of difficult airway management options to consider: mask ventilation, supraglottic airway, laryngoscopy, tracheal intubation and surgical airway. The key is to consider the patient-specific characteristics and comorbidities that could make maintaining the airway a challenge, decide which approach would be best and ensure the required tools are in the OR in the event they're needed.

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