Management of the Difficult Airway

Before the initiation of anesthetic care or airway management, ensure that an airway risk assessment is performed by the person(s) responsible for airway management whenever feasible to identify patient, medical, surgical, environmental, and anesthetic factors (e.g., risk of aspiration) that may indicate the potential for a difficult airway.

• When available in the patient’s medical records, evaluate demographic information, clinical conditions, diagnostic test findings, patient/family interviews, and questionnaire responses.

• Assess multiple demographic and clinical characteristics to determine a patient’s potential for a difficult airway or aspiration.

Before the initiation of anesthetic care or airway management, conduct an airway physical examination to further identify physical characteristics that may indicate the potential for a difficult airway.

• The physical examination may include assessment of facial features and assessment of anatomical measurements and landmarks.

• Additional evaluation to characterize the likelihood or nature of the anticipated airway difficulty may include bedside endoscopy, virtual laryngoscopy/bronchoscopy, or three-dimensional printing.

Assess multiple airway features to determine a patient’s potential for a difficult airway or aspiration.

Ensure that airway management equipment is available in the room.

Ensure that a portable storage unit that contains specialized equipment for difficult airway management is immediately available.

If a difficult airway is known or suspected:

• Ensure that a skilled individual is present or immediately available to assist with airway management when feasible.

• Inform the patient or responsible person of the special risks and procedures pertaining to management of the difficult airway.

• Properly position the patient, administer supplemental oxygen before initiating management of the difficult airway, and continue to deliver supplemental oxygen whenever feasible throughout the process of difficult airway management, including extubation.

Ensure that, at a minimum, monitoring according to the ASA Standards for Basic Anesthesia Monitoring are followed immediately before, during, and after airway management of all patients.