German guidelines for airway management 2023

Area of Science:

• Anesthesiology
• Critical Care Medicine
• Airway Management

Background:

• German airway management guidelines provide orientation for optimal patient care.
• Pre-anesthetic evaluation includes assessing anatomical and physiological indicators of difficult mask ventilation and intubation.
• Key assessment factors include mouth opening, dental status, mandibular protrusion, cervical spine mobility, and existing pathologies.

Purpose of the Study:

• To serve as an orientation and decision-making aid for optimal patient care in anesthesiology and intensive care.
• To guide the evaluation of predictors for difficult mask ventilation and endotracheal intubation.
• To recommend strategies for securing the airway, especially in anticipated and unexpected difficult scenarios.

Main Methods:

• Systematic evaluation of anatomical and physiological predictors of difficult airway management.
• Emphasis on securing the airway while maintaining spontaneous breathing when predictors are present.
• Recommendation for video laryngoscope use after unsuccessful direct laryngoscopy and for critically ill/high-risk patients.

Main Results:

• Video laryngoscopes are recommended for unexpected difficult airways and primarily for critically ill/aspiration-risk patients.
• Translaryngeal and transtracheal techniques are considered "ultima ratio" for airway management.
• Verification of endotracheal tube position using capnography is mandatory.

Conclusions:

• Optimal airway management requires thorough pre-anesthetic evaluation and appropriate technique selection.
• Availability of video laryngoscopes and proper training are crucial for effective airway management.
• Clear communication, teamwork, and capnography for verification are essential components of safe airway procedures.