Regional anesthesia in difficult airway: The quest for a solution continues

Area of Science:

• Anesthesiology
• Critical Care Medicine

Background:

• Difficult airway management presents a life-threatening challenge for anesthesiologists.
• The choice between regional anesthesia (RA) and general anesthesia (GA) is critical in these scenarios.

Purpose of the Study:

• To evaluate the role and considerations of regional anesthesia in patients with a difficult airway.
• To analyze the potential benefits and risks of RA versus GA for difficult airway management.

Main Methods:

• A comprehensive literature search was conducted using Google, PubMed, and Medscape.
• Keywords included "regional anesthesia, difficult airway, pregnancy, ventilation, intubation, epidural anesthesia, nerve blocks."
• Over 38 full-text articles and books published between 1987 and 2014 were reviewed.

Main Results:

• RA can avoid direct airway manipulation, but carries risks like total spinal block, failed RA, or local anesthetic toxicity.
• These complications may necessitate airway securing, negating RA's primary advantage.
• Careful patient assessment and consideration of unforeseen surgical complications are crucial.

Conclusions:

• The decision to use RA in a difficult airway requires thorough clinical evaluation by the anesthesiologist.
• A pre-formulated intubation strategy is essential before considering RA for patients with a known difficult airway.
• RA is not a universally safe alternative for difficult airways; careful risk-benefit analysis is paramount.