[Comparison of algorithms for management of the difficult airway]

Abstract

Management of the difficult airway and maintenance of the oxygenation are the most important tasks of the anaesthetist. Respiratory problems are still the most important single cause for anaesthesia-related accidents with poor outcome. Algorithms are step-wise procedures developed from a great number of recommendations and are well suited to automation and training procedures. There is strong agreement among consultants that specific strategies lead to improved outcome, although, strictly speaking the degree of benefit on airway management cannot be clearly determined. Several anaesthesia societies, including the American Society of Anesthesiology,have developed their own algorithms for management of the difficult airway. The comparison of published algorithms shows that the management of the anticipated difficult airway has to be performed in the awake patient and fiberoptic intubation is a crucial part of that procedure. There are different techniques (different blades, guide wire, laryngeal mask, fiber optics) for the management of the unanticipated difficult airway. The laryngeal mask, transtracheal access and the Combitube are recommended for the management of the cannot intubate, cannot ventilate situation. More important than the questions which algorithm, which technique and which instruments should be used,is that each department has and practices its own algorithm. This strongly depends on local circumstances and personal preferences. Daily practice is the condition for the successful use in an emergency situation. The management is easier if one uses a simple algorithm and as few instruments as possible.