Difficult Airway Algorithm

Question 1

ASA Difficult Airway Algorithm, Step 1:

Assess the likelihood and clinical impact of what 6 basic management problems?

Answer 1

1) Difficult mask ventilation
2) Difficult SGA placement
3) Difficult laryngoscopy
4) Difficult intubation
5) Difficult tracheostomy
6) Difficulty with Patient Cooperation or Consent

Question 2

What should be done throughout the process of difficult airway management (Step 2)?

Answer 2

Actively pursue opportunities to deliver supplemental oxygen

Question 3

What are the 2 techniques for pre-oxygenation?

Answer 3

1) Tidal volume breathing for 3-5 minutes
2) 4x deep breaths in 30 seconds

Both are equally effective in increasing PaO2

Question 4

Step 3: Consider the relative merits and feasibility of basic management choices:

Answer 4

1) Awake intubation vs. intubation after induction and paralysis
2) Non-invasive vs. invasive intubation
3) Video assisted intubation?
4) Preservation vs. ablation of spontaneous ventilation

Question 5

What is invasive airway access?

Answer 5

Surgical or percutaneous tracheostomy or cricothyroidotomy

Question 6

After a failed attempt at awake non-invasive intubation, what are the options?

Answer 6

1) Cancel the case/ awaken patient
2) Invasive airway access
3) Consider other options:
- face mask or LMA anesthesia
- local anesthesia or regional nerve blockade (IF mask ventilation not problematic)

Question 7

If intubation is unsuccessful after induction of general anesthesia, what are the 3 things to consider?

Answer 7

1) Call for help
2) Return to spontaneous ventilation
3) Awaken the patient

*meanwhile, mask ventilate

Question 8

In the Difficult Airway Algorithm, if mask ventilation (or SGA) is adequate, which pathway is followed?

Answer 8

Nonemergency Pathway

• if you can ventilate your patient, it’s not a true emergency
• utilize difficult airway cart

Question 9

What do you do if mask ventilation is not adequate?

Answer 9

• Consider/attempt a supraglottic airway (SGA)

- LMA

Question 10

What if mask ventilation AND SGA is not adequate/feasible?

Answer 10

Follow Emergency Pathway

• FIRST Call for help
• Emergency invasive airway access (trach/cric/jet/ retrograde intubation)