Subscribe to RSS
DOI: 10.1055/s-2002-20583
Troubleshooting and Managing the Difficult Airway
Publication History
Publication Date:
07 March 2002 (online)

ABSTRACT
Difficult airways are an inevitable part of the delivery of emergency and critical care. Failure to achieve or restore a patent airway can lead, in a matter of minutes, to hypoxic neurological injury and death in critically ill patients. As with many conditions, the keys to success in a moment of crisis are forethought and preparation. Clinicians should be able to recognize risk factors for difficult airways and plan accordingly. In the face of failed direct laryngoscopy, a variety of rescue techniques are available. Familiarity with many strategies, and practiced dexterity with one or two, should be part of every intensivist's plan for the management of this life-threatening problem.
KEYWORD
Cricothyrotomy - laryngeal mask airway - noninvasive positive pressure ventilation
REFERENCES
- 1 Caplan R A, Benumof J L, Berry F A. 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 . 1993; 78 597-602
- 2 Crosby E T, Cooper M R, Douglas M J. The unanticipated difficult airway and recommendations for management. Can J Anesth . 1998; 45 757-776
- 3 Mascia M F, Mattasko M T. Emergency airway management by anesthesiologists. Anesthesiology . 1993; 79 A1054
- 4 Walls R M, Barton E D, McAfee A T, for the National Emergency Airway Registry Investigators. 2,392 emergency department intubations: First report of the ongoing National Emergency Airway Registry Study (NEAR 97). Ann Emerg Med . 1999; 34 S14
- 5 Walls R M, Luten R C, Murphy M F, Schneider R E, eds.. Manual of Emergency Airway Management. Philadelphia: Lippincott Williams & Wilkins 2000
- 6 Mallampati S R, Gatt S P, Guigino L D. A clinical sign to predict difficult tracheal intubation: a prospective study. Can Anaesth Soc J . 1985; 32 429-434
- 7 Bersten A D, Holt A W, Vedig A E. Treatment of severe cardiogenic pulmonary edema with continuous positive airway pressure delivered by face mask. N Engl J Med . 1991; 325 1825-1830
- 8 Pollack C V, Torres M, Alexander L. A feasibility study of the use of bilevel positive airway pressure for respiratory support in the emergency department. Ann Emerg Med . 1996; 27 189-192
- 9 Keenan S P, Kernerman P D, Cook D J. Effect of noninvasive positive pressure ventilation on mortality in patients admitted with acute respiratory failure: a meta-analysis. Crit Care Med . 1997; 25 1685-1692
- 10 Afilalo M, Guttman A, Stern E. Fiberoptic intubation in the emergency department: a case series. J Emerg Med . 1993; 11 387-391
- 11 Brain A IJ. Historical aspects and future directions. In: Ferson DZ, Brimacombe JR, Brain AIJ, eds. International Airway Clinics: The Laryngeal Mask Airway 1998 36(2): 1-18
- 12 Caplan R, Benumof J L, Berry F A. Practice guidelines for management of the difficult airway: a report by the ASA Task Force on Management of the Difficult Airway. Anesthesiology . 1993; 78 597-602
- 13 Benumof J. Laryngeal mask airway and the ASA difficult airway algorithm. Anesthesiology . 1996; 84 686-699
- 14 Airway and Ventilation Management Working Group of the European Resuscitation Council. Guidelines for the advanced management of the airway and ventilation during resuscitation. Resuscitation . 1996; 31 201-230
- 15 Rosenblatt W H, Murphy M. The intubating laryngeal mask: use of a new ventilating-intubating device in the emergency department. Ann Emerg Med . 1999; 33 234-238
- 16 Brimacombe J R, Berry A. Mallampati classification and laryngeal mask insertion. Anaesthesia . 1993; 48 347
- 17 Pollack C V. The laryngeal mask airway: a comprehensive review for the emergency physician. J Emerg Med . 2001; 20 53-66
- 18 Asai T, Morris S. The laryngeal mask airway: its features, effects and role. Can J Anaesth . 1994; 41 930-960
- 19 Verghese C, Brimacombe J R. Survey of laryngeal mask airway usage in 11,910 patients: safety and efficacy for conventional and nonconventional usage. Anesth Analg . 1996; 82 129-133
- 20 Cooper S D, Benumoff J L, Ozaki Q T. Evaluation of the Bullard laryngoscope using the new intubating stylet: comparison with conventional laryngoscopy. Anesth Analg . 1994; 79 965-970
- 21 Pollack C V, Tiffany B R, Carty J P, Crane D M. Teaching residents new airway management techniques: initial emergency department experience with the Bullard laryngoscope. Ann Emerg Med . 1998; 32 S13
- 22 Ainsworth Q P, Howells T H. Transilluminated tracheal intubation. Br J Anaesth . 1989; 62 494-497
- 23 Hung O R, Pytka S, Morris I. Clinical trial of a new lightwand device (Trachlight) to intubate the trachea. Anesthesiology . 1995; 83 509-514
- 24 Ellis D G, Jakymec A, Kaplan R M. Success rates of blind orotracheal intubation using a transillumination technique with a lighted stylet. Ann Emerg Med . 1986; 15 138-142
- 25 Staudinger T, Brugger S, Watschinger B. Emergency intubation with the Combitube: comparison with the endotracheal airway. Ann Emerg Med . 1993; 22 1573-1575
- 26 Atherton G, Johnson J. Ability of paramedics to use the Combitube in prehospital cardiac arrest. Ann Emerg Med . 1993; 22 1263-1268
- 27 Yardy N, Hancox D, Strang T. A comparison of two airway aids for emergency use by unskilled personnel: the Combitube and the laryngeal mask. Anaesthesia . 1999; 54 181-183
- 28 Goldberg J S. Colorimetric end-tidal carbon dioxide monitoring for tracheal intubation. Anesth Analg . 1990; 70 191
- 29 Pelucio M. Out-of-hospital experience with the syringe esophageal detector device. Acad Emerg Med . 1997; 4 563
- 30 Bozeman W P. Esophageal detector device versus detection of end-tidal carbon dioxide level in emergency intubation. Ann Emerg Med . 1996; 27 5953