PRACTICE PARAMETER DIFFICULT AIRWAY INFOGRAPHIC: ADULT PATIENTS | Part 1: Preiway Manogement Decision Making Too planning) Suspected dificult laryngoscopy or intubation | tty “nth erect or video laryngoscope? ve Sie ‘Significantly incroased risk of aspiration? = - Hr = Increased sak of rapid desaturation? L: ‘Pert 2: Awake Alay Management Par 3 Aiwray Managemeot wih induction of Anesthesia Fig. 3. Diiclt airway ifographic: Adult patient example. This figure provides throe tools to aid in away management forthe patient with ‘planned, anticipated dificult, or unanticipated dificult airway. Part 7is a decision tool that incorporates relevant elements of evaluation ‘and is intended to assist inthe decision to enter the awake airway management pathway or the airway management with the induction of ‘anesthesia pathway of the ASA dificult airway algorithm. Pat isan awake intubation algorithm. Pat is a strategy for managing pationts with induction of anesthesia when an urantcpated difficulty with venation (as determined by capnograph) with a planned airway tech- rique is encountered The alway manager's assessment and choice of techniques should be based on their previous experience; availa resources, including equipment, availabilty, and competency of help; and the context in which ainway management will occur "Review airway strategy: Consider anatomical/prysilogic airway cifculty risk. aspiration ris, infection risk, other exposure risk, equipment and ‘monitoring check, role assignment, and backup and rescue plans. Awake tecnniques include flexible intubation scope, vdeolaryngoscopy, direct laryngoscopy, supragotic airway, combined devices, and retrograde wire-aided. ‘Adequate ventilation by any means (eg. face ‘mask. supragltic airway, tracheal intubation) shouldbe confirmed by capnography, when possible. Follow-up care includes postextuba- tion care (ie. steroids, racemic epinephrine), counseling, documentation, team debriefing, and encouraging patent dificult arway registry. ‘Postpone the case/intubation and retum with appropriate resources (e.., personnel, equipment, patient preparation, awake intubation) ‘Invasive airways include surgical crcothyroidotomy, needle crcotryoidotomy with a pressure-regulated device arge-bore cannula cri- cothyroidtomy, or surgical tracheostomy. Elective invasive aways Include the above, retrograde wire—guided intubation, and percutaneous ‘tracheostomy. Other options include rigid bronchoscopy and ECMO. *nvasve airway is performed by an individual trained in invasive away techniques, whenever possible. tn an unstable situation or when airway management is mandatory after a failed awake intubation, a switch to the airway management withthe induction of anesthesia pathway may be entered with preparation for an emergency invasive airway. 'Low- or high-low nasal cannula, head elevated position throughout procedure. Noninvasive ventilation during preoxygenation. The intent of liming attempts at tracheal intubation and supraglottcaiway insertion isto reduce te isk of bleeding, edema, and other types of trauma. that may increase the diicully of mask ventilation and/or subsequent attempts to secure a defintive airway. Persistent attempts at any airway intervention, including inetfective mask ventiation, may delay obtaining an emergency invasive arway. A reasonable approach may be to limit attempts with any technique class (Le. face mask, supraglottc airway tracheal tube) to three with one additonal attempt by a clinician with higher skits. “Optimize: suction, relaxants, repositioning. Face mask: oralnasal away, two-hand mask grip. Supraglottic airway: size, design, repositioning fst versus second generation. Tracheal tube: introducer, rigid stylet hyperangulated vdeolaryngoscopy. blade size extemal laryngeal manipulation. Consider other causes of inadequate ventilation (including but not limited to laryngospasm and bronchospasm. First versus second generation supraglotic airway with intubation capability for inital or rescue supraglottc airway. Vide ‘laryngoscopy as an option for ital or rescue tracheal intubation. (Continued i : : t z | i | i € i i = ot ‘Avesnasiloyy 2022 13631-81 PravceGudetes Copyright © 2021, the American Society of Anesthes! this article is prohibited, is, All Righis Reserved, Unauthorized reproduct