Airway Management Devices and Approaches

Adverse outcomes associated with the management of a difficult airway include death, hypoxic injury, myocardial infarction, cardiopulmonary arrest, unnecessary tracheostomy, airway trauma, and dental injury. The ASA published its first version of the ASA Difficult Airway algorithm in 1993, which the ASA Task Force on the Management of the Difficult Airway updated in 2003 (see algorithm below). The goal of the ASA Algorithm (Fig. 33) is to facilitate the management of the difficult airway and reduce the likelihood of an adverse outcome [20]. With so many devices and techniques for dealing with the difficult airway, many airway problems can now be overcome. This requires good clinical judgment, experience, and familiarity with the use of the airway devices and techniques. In the face of an emergency, the practitioner tends to revert to the use of the technique with which he or she is most familiar. Practitioners should familiarize themselves with several techniques for managing the difficult airway other than direct laryngoscopy, however. With repeated practice, the practitioner will increase his or her chances of success. Ultimately, it is more important to know how to use a few devices well than to barely know how to use them all. And do not forget, call for help.