[Difficult intubation: decision-making algorithms in the main operating suite of the University Hospital Center]

In the setting of an operative suite or in the case of cardio-pulmonary resuscitation, processing algorithms are mandatory for acute crisis situations like the difficult intubation. The following recommendations have been prescribed as applicable for a teaching hospital (CHUV, Lausanne), based on three different possibilities (expected difficult intubation in elective cases, expected difficulties in emergency cases, and unexpected difficulties): awake intubation under topical and local anesthesia, if possible by fibroscopy, for all cases where difficult intubation is expected; steps for unexpected difficult intubation: laryngoscopy with flexible stylettes and special blades, laryngeal mask, trans-tracheal jet-ventilation, rigid tracheo-bronchoscopy by ENT specialist, rescue coniotomy, tracheotomy; tracheal overpressure with transtracheal O2 ventilation in "full stomach" emergency cases; limited number and length of time for intubation trials; keep oxygen inflow during and/or between the intubation attempts; return to spontaneous ventilation as soon as possible. The three algorithms are presented and commented.