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Review
. 2023 Aug 1;12(4):545-566.
doi: 10.21037/hbsn-23-46. Epub 2023 May 19.

Expert consensus on difficult airway assessment

Ming Xia  1 , Wuhua Ma  2 , Mingzhang Zuo  3 , Xiaoming Deng  4 , Fushan Xue  5 , Denise Battaglini  6 , Vivek Aggarwal  7 , Giustino Varrassi  8 , Vladimir Cerny  9 , Ida Di Giacinto  10 , Rita Cataldo  11 , Daqing Ma  12 , Toru Yamamoto  13 , Martina Rekatsina  14 , Alessandro De Cassai  15 , Andrea Carsetti  16   17 , Marvin G Chang  18 , Edwin Seet  19   20 , Daniel P Davis  21   22 , Michael G Irwin  23 , Yuguang Huang #  24 , Hong Jiang #  1
Affiliations
Review

Expert consensus on difficult airway assessment

Ming Xia et al. Hepatobiliary Surg Nutr. .

Abstract

Background: Identifying a potentially difficult airway is crucial both in anaesthesia in the operating room (OR) and non-operation room sites. There are no guidelines or expert consensus focused on the assessment of the difficult airway before, so this expert consensus is developed to provide guidance for airway assessment, making this process more standardized and accurate to reduce airway-related complications and improve safety.

Methods: Seven members from the Airway Management Group of the Chinese Society of Anaesthesiology (CSA) met to discuss the first draft and then this was sent to 15 international experts for review, comment, and approval. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) is used to determine the level of evidence and grade the strength of recommendations. The recommendations were revised through a three-round Delphi survey from experts.

Results: This expert consensus provides a comprehensive approach to airway assessment based on the medical history, physical examination, comprehensive scores, imaging, and new developments including transnasal endoscopy, virtual laryngoscopy, and 3D printing. In addition, this consensus also reviews some new technologies currently under development such as prediction from facial images and voice information with the aim of proposing new research directions for the assessment of difficult airway.

Conclusions: This consensus applies to anesthesiologists, critical care, and emergency physicians refining the preoperative airway assessment and preparing an appropriate intubation strategy for patients with a potentially difficult airway.

Keywords: Expert consensus; airway management; difficult airway.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://hbsn.amegroups.com/article/view/10.21037/hbsn-23-46/coif). VC reports institutional research grants from Charles University in Prague at University Hospital Hradec Kralove in different areas of interest, received consulting fees from in the past 5 years from Behring, Baxter, BBraun, Octapharma, and he serves as expert court witness for the area of anesthesia and intensive care 25 years and he is President of the Czech Society of Anesthesiology and Intensive Care. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Cervical spine mobility.
Figure 2
Figure 2
The modified Mallampati test.
Figure 3
Figure 3
The detailed bedside tests include neck circumference, thyromental distance, sternomental distance, hyomental distance, thyromental height.
See this image and copyright information in PMC

References

    1. Apfelbaum JL, Hagberg CA, Connis RT, et al. 2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway. Anesthesiology 2022;136:31-81. 10.1097/ALN.0000000000004002 - DOI - PubMed
    1. Cook TM, Woodall N, Frerk C, et al. 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. Br J Anaesth 2011;106:617-31. 10.1093/bja/aer058 - DOI - PubMed
    1. Griesdale DE, Bosma TL, Kurth T, et al. Complications of endotracheal intubation in the critically ill. Intensive Care Med 2008;34:1835-42. 10.1007/s00134-008-1205-6 - DOI - PubMed
    1. Jaber S, Amraoui J, Lefrant JY, et al. Clinical practice and risk factors for immediate complications of endotracheal intubation in the intensive care unit: a prospective, multiple-center study. Crit Care Med 2006;34:2355-61. 10.1097/01.CCM.0000233879.58720.87 - DOI - PubMed
    1. Schwartz DE, Matthay MA, Cohen NH. Death and other complications of emergency airway management in critically ill adults. A prospective investigation of 297 tracheal intubations. Anesthesiology 1995;82:367-76. 10.1097/00000542-199502000-00007 - DOI - PubMed