[Difficult airways--why do we need algorithms]

The difficult airway and/or intubation are still one of the most important challenges for anaesthesiologists. Recent clinical trials reported a decrease in the number of fatal cases associated with a difficult airway; however, these complications are still among the major causes of severe morbidity and mortality in anaesthesiology. Severe anaesthesiological complications including serious hypoxia, brain damage and death occur mostly during induction of anaesthesia, and are often related to a difficult airway. The term is often misinterpreted, and relates to failed intubation, difficult tracheal intubation, difficult laryngoscopy, and/or difficult mask ventilation. Difficult intubation is not easy to anticipate. The majority of prognostic methods, i.e. assessment scales accepted in clinical practice, are not satissfactory. Up to 40% of tracheal intubations preoperatively anticipated as difficult are performed without problems. In some cases, however, the procedure proves difficult only on direct laryngoscopy. This review presents current reports and statistical analysis of serious airway-related incidents in medical practice, and indicates the need for the introduction of mandatory guidelines for difficult airway assessment and management in clinical practice.