Airway Management in the Adult

Carlos A. Artime et al.

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Key Points

One of the fundamental responsibilities of the anesthesiologist is to mitigate the adverse effects of anesthesia on the respiratory system by maintaining airway patency and ensuring adequate ventilation and oxygenation. The term airway management refers to this practice and is a cornerstone of anesthesia.

- Successful airway management requires a range of knowledge and skill sets – specifically, the ability to predict difficulty with airway management and to formulate an airway management strategy, as well as the skills to execute that strategy using the wide array of airway devices available.

- The American Society of Anesthesiologists' (A.S.A) Practice Guidelines for Management of the Difficult Airway and the accompanying difficult airway algorithm provide guidelines for evaluating the airway and preparing for difficult airway management and can guide clinical decision-making when an anesthesiologist is faced with a known or potentially difficult airway. Cognitive aids, such as the Vortex Approach and the new A.S.A Difficult Airway infographics that accompany the A.S.A adult and pediatric difficult airway algorithms, are useful to help implement airway algorithms in an emergency.

- A detailed understanding of airway anatomy is essential for successful airway management.

- A complete evaluation of the airway and knowledge of difficult airway predictors can alert the anesthesiologist to the potential for difficulty with airway management and allow for appropriate planning.

- Apneic oxygenation can be used to prolong the duration of apnea without desaturation and is increasingly being adopted during the management of both difficult and routine airways.

- Application of local anesthesia to the airway or induction of general anesthesia is usually required to facilitate airway management, to provide comfort for the patient, and to blunt airway reflexes and the hemodynamic response to airway instrumentation.

- Over the past 40 years, supraglottic airways (S.G.A's) have been one of the most important developments in airway devices.

- Tracheal intubation establishes a definitive airway, provides maximal protection against aspiration of gastric contents, and allows for positive-pressure ventilation with higher airway pressures than via a face mask or S.G.A.

- Flexible scope intubation of the trachea in an awake, spontaneously ventilating, and cooperative patient is the gold standard for the management of the anticipated difficult airway.

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