Difficult Airways: a Touchestone of Quality of Anaesthesia Care

Overview

Anaesthetists occasionally encounter difficulties in securing the airways in their practice. These difficulties are eitheranticipated or unanticipated and include difficult laryngoscopy, difficult or failed intubation and “can’t intubate, can’tventilate situation“. A wrong and inapt management of difficult airways puts the patients at risk of serious morbidity,hypoxaemic brain damage and death. In order to decrease the risk, anaesthetists must know the guidelines and algorithmsfor difficult airway management and must be able to apply them as needed. Anaesthetists acquire and refresh theirknowledge and practical skills both by training on manikins and simulators and on patients in daily practice of anaesthesia.The proper management of difficult airway is primarily based on the use of elastic bougie, laryngeal masks, fibreopticbronchoscopy and cricothyreoidectomy. Many novel ventilation and intubation tools have been developed but the proof oftheir utility is still to come. The published algorithms should be modified according to local skills and resources to facilitatetheir application. Today, there is no place for morbidity and mortality in relation to difficult airways.

Key words:
algorithm – difficult airways – fibreoptic intubation – laryngeal mask