Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2023 Feb 17;15(2):e35117.
doi: 10.7759/cureus.35117. eCollection 2023 Feb.

Innovations in the Management of the Difficult Airway: A Narrative Review

Binu Ravindran  1
Affiliations
Review

Innovations in the Management of the Difficult Airway: A Narrative Review

Binu Ravindran. Cureus. .

Abstract

The difficult airway (DA) remains a perpetual challenge and its implications have led to multiple advances, technological and otherwise in this area. This article investigates the latest developments in the definition, prediction tools and diagnostics like airway and neck Ultrasonography (USG), Magnetic Resonance Imaging (MRI) and Computed tomography (CT) scans, preoperative Virtual endoscopy (VE) and 3D printing. Innovations in airway devices and adjuncts are analysed. Difficult airway society (DAS) guidelines, American Society of Anaesthesiologists (ASA) Practice Guidelines and Vortex approach for the management of DA are explored. Other breakthroughs include novel oxygen supplementation techniques throughout airway management and tools like Anaesthesia Information Management Systems (AIMS) and Clinical Decision Support (CDS) systems. The delivery of DA training and patient counselling has also undergone vast changes with emerging technology like Virtual Reality (VR), mobile applications and toolkits. The enormous, ever-evolving and endless possibilities in this area have only helped improve clinical standards and enhance patient safety.

Keywords: airway equipment; airway training; anaesthesia; diagnostic imaging; difficult airway; intensive care; radiology.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Cricothyroid membrane (CM) in transverse view with reverberation artifacts (RA) at the tissue air border.
The image is the original work of the author.
Figure 2
Figure 2. Virtual endoscopy reconstruction of glottis (bottom right) from Computed Tomography images (top and left)
Source: Ahmad I, Keane O, Muldoon S. Enhancing airway assessment of patients with head and neck pathology using virtual endoscopy. Indian J Anaesth. 2017 Oct;61(10):782-786. doi: 10.4103/ija.IJA_588_17. PMID: 29242648; PMCID: PMC5664881.
Figure 3
Figure 3. A patient-specific phantom for difficult tracheal intubation simulator. (A) and (B) Assembly of the inner parts: the skull, maxilla, mandible, cervical-spine, airway and tongue. (C) Final phantom with skin. (D) Intubation with Macintosh blades in the phantom with mouth opening.
Source: Ock, J., Gwon, E., Kim, Dh. et al. Patient-specific and hyper-realistic phantom for an intubation simulator with a replaceable difficult airway of a toddler using 3D printing. Sci Rep 10, 10631 (2020). https://doi.org/10.1038/s41598-020-67575-5 This image is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.
Figure 4
Figure 4. Video laryngoscope with disposable blade.
The image is the original work of the author.
Figure 5
Figure 5. Disposable Fibreoptic Ambu aScope
The image is the original work of the author.
Figure 6
Figure 6. Ventrain (Ventinova, Netherlands)
Courtesy Ventinova Medical B.V.
See this image and copyright information in PMC

References

    1. Major complications of airway management in the UK: results of the fourth National Audit Project of the Royal College of Anaesthetists and the difficult Airway Society. Part 1: anaesthesia. Cook TM, Woodall N, Frerk C. Br J Anaesth. 2011;106:617–631. - PubMed
    1. 2022 American Society of Anesthesiologists practice guidelines for management of the difficult airway. Apfelbaum JL, Hagberg CA, Connis RT, et al. Anesthesiology. 2022;136:31–81. - PubMed
    1. The American Society of Anesthesiologists closed claims project: what have we learned, how has it affected practice, and how will it affect practice in the future? Cheney FW. Anesthesiology. 1999;91:552–556. - PubMed
    1. Criteria for estimating likelihood of difficulty of endotracheal intubation with the Macintosh laryngoscope. Bellhouse CP, Doré C. Anaesth Intensive Care. 1988;16:329–337. - PubMed
    1. Ultrasonographic assessment of airway. Jain K, Yadav M, Gupta N, Thulkar S, Bhatnagar S. J Anaesthesiol Clin Pharmacol. 2020;36:5–12. - PMC - PubMed