[Cannot intubate, cannot ventilate: airway management of difficult airways in adults]

Cannot intubate, cannot ventilate (CICV) is one major cause of death associated with general anesthesia and thus proper airway management plans are necessary. To achieve safe airway management, it is necessary first to predict if the patient's trachea can be difficult to intubate or the lungs difficult to ventilate. When difficulty is predicted, the following factors should be considered: (1) if general anesthesia is truly necessary; (2) if tracheal intubation is mandatory; (3) if muscle relaxation is required; (4) if awake intubation is safer; (5) if surgical airway is required; and (6) if tracheal intubation can prevent airway obstruction. When CICV occurred after general anesthesia, it is important to remember that the primary task is to oxygenate the patient, and not to intubate the trachea: the patient may need to be awaken, surgical airway obtained, or cardiopulmonary bypass established. To make a right decision, it is necessary to know the advantages and disadvantages of each option, as well as of each airway device, and to be acquainted with these devices during routine anesthesia. In this article, I will present six typical cases of difficult airways, and will discuss appropriate options for safer airway management.