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Management of the difficult airway
D E Schwartz1, J P Wiener-Kronish
1Department of Anesthesia, University of California, San Francisco.
Clinics in Chest Medicine
|September 1, 1991
Summary
Develop a difficult airway management plan before encountering unexpected challenges. Prepare equipment and skilled personnel for failed intubation, prioritizing awake fiberoptic intubation and escalating interventions if initial attempts are unsuccessful.
Area of Science:
- Anesthesiology
- Critical Care Medicine
- Emergency Medicine
Background:
- Effective airway management is crucial for patient safety.
- Unexpected difficult airways and failed intubations pose significant clinical challenges.
- Pre-planning and preparedness are essential for managing complex airway scenarios.
Purpose of the Study:
- To outline a strategic approach for managing difficult airways and failed intubations.
- To emphasize the importance of advance preparation and readily available equipment.
- To provide a stepwise protocol for clinicians facing challenging intubation scenarios.
Main Methods:
- Anticipating difficult airways and ensuring necessary equipment and personnel (e.g., surgeon for tracheotomy) are available.
- Prioritizing awake intubation, preferably with a fiberoptic bronchoscope, when difficulty is predicted.
- Implementing a sequential approach for unexpected failed intubations, including checking head position, mask ventilation, selecting alternative equipment, and summoning assistance.
Main Results:
- A structured, multi-step approach increases the likelihood of successful airway management.
- Early recognition and preparation for difficult airways are critical.
- Escalating interventions, including specialized techniques and experienced personnel, are necessary when initial attempts fail.
Conclusions:
- A well-defined plan for difficult airway management and failed intubation is essential for all clinicians.
- Preparedness, including equipment and skilled assistance, significantly impacts patient outcomes.
- A systematic, stepwise approach, escalating to invasive methods if necessary, ensures airway security.