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How Do I Prepare Myself and My Staff for a Difficult Airway?

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Practical Trends in Anesthesia and Intensive Care 2019

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Abstract

Airway management is a broad term summarizing a large number of procedures and techniques targeted to airway control and with the common aim to oxygenate the brain ventilating the lungs.

Failed intubation, ventilation, or oxygenation still remains a cause of perioperative and periprocedural adverse events, and many guidelines have been developed to provide optimal care.

A proper airway management prediction process should be part of any procedure, not only aimed to predict a difficult airway, but also mostly to develop an adequate strategy tailored to the patient.

Many tools are nowadays available, with a growing role of videolaryngoscopes to manage advanced difficult scenarios, but still a significant advantage over direct laryngoscopy to be clearly demonstrated. Supraglottic devices have evolved, allowing not only the rescue of a failed intubation/ventilation but also suggesting a broader use in routine practice. Awake techniques, including either flexible scopes or videolaryngoscopes, gain indications, popularity, and feasibility, allowing a safer airway management, especially when difficult ventilation is expected. Airway exchange procedures and safe extubation policies remain important techniques to extend airway safety in the perioperative period, whereas emergency cricothyrotomy, though being the cannot intubate–cannot oxygenate scenario incidence lower than in the past, still remains an underused technique with lack of knowledge and delayed performance.

Finally, the human factor seems to be today the most relevant issue related to airway accidents, and a lot of efforts in teaching and training should be focused on this approach, including simulation, teamwork, and finalized education.

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Acknowledgments

Financial disclosure: none.

Conflict of interest: MS was involved in research and development and preclinical testing of the LMAProtector™, was a paid consultant with Teleflex Medical, Dublin, Ireland, is a patent owner (no royalties), and was a paid consultant with DEAS, Castelbolognese, Italy.

IDG declares no Conflict of Interest.

RC declares no Conflict of Interest.

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Authors and Affiliations

  1. Anaesthesia and Intensive Care—AOU Policlinico Vittorio Emanuele, Catania, Italy

    Massimiliano Sorbello

  2. Anaesthesia, Polyvalent Intensive Care and Transplantation Unit, Department of Organ Failure and Transplantation, S. Orsola-Malpighi Hospital, Bologna, Italy

    Ida Di Giacinto

  3. Unit of Anesthesia, Intensive Care and Pain Management, Department of Medicine, Campus Bio-Medico University, Rome, Italy

    Rita Cataldo

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  1. Massimiliano Sorbello
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  2. Ida Di Giacinto
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  3. Rita Cataldo
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  1. San Paolo Hospital, Intensive Therapy Department, University of Milan, Milan, Italy

    Davide Chiumello

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Sorbello, M., Di Giacinto, I., Cataldo, R. (2020). How Do I Prepare Myself and My Staff for a Difficult Airway?. In: Chiumello, D. (eds) Practical Trends in Anesthesia and Intensive Care 2019. Springer, Cham. https://doi.org/10.1007/978-3-030-43873-9_14

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