MetroHealthAnesthesiaThe Difficult Airway - 4

Can we predict difficult DL? So, what do we do?

A. Most adverse outcomes occur when airway difficulty is not anticipated.
B. Latto et al (1985) (Maybe we are a bit better now.):
43 difficult DL's in 1200 prospective patients:
50% of difficult DL's were NOT anticipated.
Only 25% of DL's that were expected to be difficult
actually were difficult.
So, 50% of difficult DL's can be predicted
with 3 times that many false positives.
C. NO, we cannot rule out difficult DL, yet, so ALWAYS BE PREPARED.
Choose an alternative technic and enjoy using it regularly! You will maintain proficiency by using your alternate technic as the first line techic whenever difficult DL seems a good possibility (about 5% of your patients). Then, when unanticipated difficulty arises, your alternate technic will be a natural and successful second choice.

General Preparation for Difficult Airway

A. Difficult airway box or kit available
B. LMA's available
C. Inform patient of plan
D. Assistant(s) available
E. Supplemental oxygen
F. Equipment for transtracheal jet ventilation

The ASA Difficult Airway Algorithm 2003

The ASA Difficult Airway Algorithm Incorporating the LMA

Alternative Intubation Technics

  1. Blind Nasotracheal Intubation
  2. Digital Assisted Intubation
  3. Fiberoptic Intubation
  4. GlideScope Video Laryngoscope
  5. Gum Elastic Bougie Assisted Intubation
  6. LMA Assisted Fiberoptic Intubation
  7. Retrograde Intubation
  8. Wuscope Intubation

Greg Gordon MD