Understanding Anesthesiology - The Global Regional Anesthesia ...

Difficult airway
The American Society of Anesthesiologists Task Force has defined the difficult airway as follows:
“The clinical situation in which a conventionally trained anesthesiologist experiences
difficulty with mask ventilation, difficulty with tracheal intubation, or both.”
The report contained some more specific definitions.
For example, difficult laryngoscopy is when no part of the larynx is visualized with direct
laryngoscopy; difficult endotracheal intubation is when intubation requires more than
three attempts or more than 10 minutes.
The incidence of the difficult airway has been reported to be greater in the obstetrical population
(8%) than in the non-obstetrical surgical population (around 2%) although some studies
have called this conventional thinking into question.
The keys to the management of the difficult airway can be summarized as follows:
a) to do a careful airway assessment in all patients in order to avoid the unanticipated difficult
airway wherever possible.
b) to prioritize the establishment of ventilation (with mask or laryngeal mask) when a difficult
intubation is encountered.
c) to avoid persistent, traumatic attempts at airway instrumentation.
d) to be comfortable moving to a surgical airway if neither intubation nor bag mask ventilation
can be achieved.
e) to develop and maintain skills with a range of airway devices and adjuncts.
Reference: Caplan RA, Benumof JL, Berry FA, et al: Practice guidelines for management of the difficult airway. A report by the
American Society of Anesthesiologists Task Force on Management of the Difficult Airway, Anesthesiology 78:597,1993.
Related Glossary Terms
Adjunct, Airway assessment, Antisialagogue, Cormack Lehane, Direct laryngoscopy, Extubation,
Fibreoptic bronchoscope, Hypoxemia, Intubation, Laryngeal mask airway (LMA), Laryngoscope,
Macintosh blade, Magill blade, Mallampati classification, Mouth opening,
Neck motion, Needle cricothyrotomy, Pre-oxygenation, Sniffing position, Stylet, Thyromental
Distance, Videolaryngoscope
Index
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Chapter 1 - Airway Management
Chapter 1 - Airway Management
Chapter 1 - Airway Management
Chapter 3 - General Anesthesia
Chapter 5 - Obstetrical Anesthesia
Chapter 5 - Obstetrical Anesthesia