Multidisciplinary international expert consensus on perioperative airway management

Hengrui Liang¹, Guowei Che², Fei Cui¹, Junguo Dong¹, Weiquan Gu³, Chundong Gu⁴, Shun Xu⁵, Yufeng Ba⁶, Kaican Cai⁷, Qingdong Cao⁸, Chang Chen⁹, Chun Chen¹⁰, Qixun Chen¹¹, Liyang Cheng¹², Gang Feng¹³, Yunjiu Gou¹⁴, Wenwei Guo¹, Jinxi He¹⁵, Junming He¹⁶, Jian Hu¹⁷, Ying Huang¹, Wenxi Wang¹, Wenjie Jiao¹⁸, Shunjun Jiang¹, Jun Liu¹, Lan Lan¹⁹, Wei Li²⁰, Xiaofei Li²¹, Zhongcheng Li²², Yin Li²³, Zhu Liang²⁴, Hongxu Liu²⁵, Yingbin Liu^{26

27}, Xinyu Mei²⁸, Xicheng Song²⁹, Daqiang Sun³⁰, Hui Tian³¹, Ziqiang Tian³², Jianhua Wang³³, Guangsuo Wang³⁴, Xin Xu¹, Xudong Xiang³⁵, Guobing Xu¹⁰, Tao Xue³⁶, Chao Yang¹, Xiaolong Yan³⁷, Nuo Yang³⁸, Feng Yao³⁹, Dalong Yin⁴⁰, Xiaochuan Yin⁴¹, Bentong Yu⁴², Wei Zhai⁴³, Yu Zhang^{44

45}, Guangjian Zhang⁴⁶, Xiaowen Zhang⁴⁷, Qiang Zhang⁴⁸, Yi Zhang⁴⁹, Jun Zhao⁵⁰, Haihui Zhong⁵¹, Alessandro Brunelli⁵², Till Ploenes^{53

54}, Luca Bertolaccini⁵⁵, John Kit Chung Tam^{56

57}, Min P Kim⁵⁸, Majed Refai⁵⁹, Michel Gonzalez⁶⁰, Adam R Dyas⁶¹, Nicoletta Pia Ardò⁶², Hiran C Fernando⁶³, Giulio Maurizi⁶⁴, Gregor J Kocher⁶⁵, Giuseppe Marulli^{66

67}, Álvaro Fuentes-Martín⁶⁸, Gianluca Perroni⁶⁹, Kyung Soo Kim⁷⁰, Maria Rodriguez⁷¹, Marcus Taylor⁷², Xusen Zou¹, Wei Wang¹, Jianxing He¹

Affiliations

¹ Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China.
² Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.
³ Department of Thoracic Surgery, The First People's Hospital of Foshan, Foshan, China.
⁴ Department of Thoracic Surgery, the First Affiliated Hospital of Dalian Medical University, Dalian, China.
⁵ Department of Thoracic Surgery, The First Hospital of China Medical University, Shenyang, China.
⁶ Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China.
⁷ Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China.
⁸ Department of Thoracic Surgery and Lung Transplantation, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China.
⁹ Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China.
¹⁰ Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
¹¹ Department of Thoracic Oncological Surgery, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, China.
¹² Department of General Surgery, the General Hospital of Southern Theater Command, People's Liberation Army (PLA), Guangzhou, China.
¹³ Department of Thoracic Surgery, School of Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.
¹⁴ Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou, China.
¹⁵ Department of Thoracic Surgery, General Hospital of Ningxia Medical University, Yinchuan, China.
¹⁶ Department of Hepatobiliary Surgery, Guangdong Province Traditional Chinese Medical Hospital, Guangzhou, China.
¹⁷ Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
¹⁸ Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao, China.
¹⁹ Department of Anesthesia, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
²⁰ Department of Thoracic Surgery, Weifang People's Hospital, Weifang, China.
²¹ Department of Thoracic Surgery, Xi'an International Medical Centre Hospital, Northwestern University, Xi'an, China.
²² Department of Thoracic and Cardiovascular Surgery, Affiliated Hospital of Qinghai University, Xining, China.
²³ Section of Esophageal and Mediastinal Oncology, Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
²⁴ Department of Cardiothoracic Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China.
²⁵ Department of Thoracic Surgery, Liaoning Cancer Hospital & Institute, Shenyang, China.
²⁶ State Key Laboratory of Systems Medicine for Cancer, Shanghai Cancer Institute, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
²⁷ Department of Biliary-Pancreatic Surgery, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
²⁸ Department of Thoracic Surgery, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, China.
²⁹ Department of Otorhinolaryngology, Head and Neck Surgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China.
³⁰ Department of Thoracic Surgery, Tianjin Chest Hospital, Tianjin University, Tianjin, China.
³¹ Department of Thoracic Surgery, Qilu Hospital of Shandong University, Jinan, China.
³² Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China.
³³ Second Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an, China.
³⁴ Department of Thoracic Surgery, The Second Clinical Medical College of Jinan University, Shenzhen People's Hospital, Shenzhen, China.
³⁵ No. 2 Department of Thoracic Surgery, The Third Affiliated Hospital of Kunming Medical University, Kunming, China.
³⁶ Department of Cardiothoracic Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China.
³⁷ Department of Thoracic Surgery, Tangdu Hospital, The Air Force Military Medical University, Xi'an, China.
³⁸ Department of Thoracic and Cardiovascular Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.
³⁹ Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
⁴⁰ Department of Hepatobiliary Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China.
⁴¹ Department of Thoracic Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming, China.
⁴² Department of Thoracic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China.
⁴³ Department of Thoracic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
⁴⁴ Department of Otolaryngology, Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China.
⁴⁵ Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, Yantai, China.
⁴⁶ Department of Thoracic Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
⁴⁷ Department of Otolaryngology-Head and Neck Surgery, The Key Laboratory of Advanced Interdisciplinary Studies Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
⁴⁸ Department of Thoracic Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China.
⁴⁹ Department of Thoracic Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
⁵⁰ Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China.
⁵¹ Department of Thoracic Surgery, Meizhou People's Hospital, Meizhou, China.
⁵² Department of Thoracic Surgery, St. James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
⁵³ Division of Thoracic Surgery, Department of Visceral, Thoracic and Vascular Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
⁵⁴ Department of Thoracic Surgery, Fachkrankenhaus Coswig, Coswig, Germany.
⁵⁵ Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy.
⁵⁶ Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
⁵⁷ Department of Cardiac, Thoracic, and Vascular Surgery, National University Heart Centre Singapore, Singapore, Singapore.
⁵⁸ Division of Thoracic Surgery, Department of Surgery, Houston Methodist Hospital, Houston, TX, USA.
⁵⁹ Department of Thoracic Surgery, Ospedali Riuniti delle Marche, Ancona, Italy.
⁶⁰ Department of Thoracic Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
⁶¹ Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA.
⁶² Thoracic Surgery Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.
⁶³ Department of Cardiothoracic Surgery, Allegheny General Hospital, Pittsburgh, PA, USA.
⁶⁴ Division of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
⁶⁵ Department of Thoracic Surgery, Hirslanden Clinic Beau Site, Bern, Switzerland.
⁶⁶ Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.
⁶⁷ Thoracic Surgery Unit-IRCCS Humanitas Research Hospital, Rozzano, Italy.
⁶⁸ Thoracic Surgery Department, University Clinical Hospital of Valladolid, University of Valladolid, Valladolid, Spain.
⁶⁹ Division of Thoracic Surgery, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella, Italy.
⁷⁰ Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
⁷¹ Thoracic Surgery Department, Clínica Universidad de Navarra, Madrid, Spain.
⁷² Department of Cardiothoracic Surgery, Manchester University Hospital Foundation Trust, Wythenshawe Hospital, Manchester, UK.

PMID: 40386733
PMCID: PMC12082217
DOI: 10.21037/tlcr-2025-273

Review

Multidisciplinary international expert consensus on perioperative airway management

Hengrui Liang et al. Transl Lung Cancer Res. 2025.

. 2025 Apr 30;14(4):1042-1060.

doi: 10.21037/tlcr-2025-273. Epub 2025 Apr 16.

Authors

Affiliations

¹ Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China.
² Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.
³ Department of Thoracic Surgery, The First People's Hospital of Foshan, Foshan, China.
⁴ Department of Thoracic Surgery, the First Affiliated Hospital of Dalian Medical University, Dalian, China.
⁵ Department of Thoracic Surgery, The First Hospital of China Medical University, Shenyang, China.
⁶ Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China.
⁷ Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China.
⁸ Department of Thoracic Surgery and Lung Transplantation, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China.
⁹ Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China.
¹⁰ Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
¹¹ Department of Thoracic Oncological Surgery, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, China.
¹² Department of General Surgery, the General Hospital of Southern Theater Command, People's Liberation Army (PLA), Guangzhou, China.
¹³ Department of Thoracic Surgery, School of Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.
¹⁴ Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou, China.
¹⁵ Department of Thoracic Surgery, General Hospital of Ningxia Medical University, Yinchuan, China.
¹⁶ Department of Hepatobiliary Surgery, Guangdong Province Traditional Chinese Medical Hospital, Guangzhou, China.
¹⁷ Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
¹⁸ Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao, China.
¹⁹ Department of Anesthesia, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
²⁰ Department of Thoracic Surgery, Weifang People's Hospital, Weifang, China.
²¹ Department of Thoracic Surgery, Xi'an International Medical Centre Hospital, Northwestern University, Xi'an, China.
²² Department of Thoracic and Cardiovascular Surgery, Affiliated Hospital of Qinghai University, Xining, China.
²³ Section of Esophageal and Mediastinal Oncology, Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
²⁴ Department of Cardiothoracic Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China.
²⁵ Department of Thoracic Surgery, Liaoning Cancer Hospital & Institute, Shenyang, China.
²⁶ State Key Laboratory of Systems Medicine for Cancer, Shanghai Cancer Institute, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
²⁷ Department of Biliary-Pancreatic Surgery, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
²⁸ Department of Thoracic Surgery, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, China.
²⁹ Department of Otorhinolaryngology, Head and Neck Surgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China.
³⁰ Department of Thoracic Surgery, Tianjin Chest Hospital, Tianjin University, Tianjin, China.
³¹ Department of Thoracic Surgery, Qilu Hospital of Shandong University, Jinan, China.
³² Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China.
³³ Second Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an, China.
³⁴ Department of Thoracic Surgery, The Second Clinical Medical College of Jinan University, Shenzhen People's Hospital, Shenzhen, China.
³⁵ No. 2 Department of Thoracic Surgery, The Third Affiliated Hospital of Kunming Medical University, Kunming, China.
³⁶ Department of Cardiothoracic Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China.
³⁷ Department of Thoracic Surgery, Tangdu Hospital, The Air Force Military Medical University, Xi'an, China.
³⁸ Department of Thoracic and Cardiovascular Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.
³⁹ Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
⁴⁰ Department of Hepatobiliary Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China.
⁴¹ Department of Thoracic Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming, China.
⁴² Department of Thoracic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China.
⁴³ Department of Thoracic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
⁴⁴ Department of Otolaryngology, Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China.
⁴⁵ Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, Yantai, China.
⁴⁶ Department of Thoracic Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
⁴⁷ Department of Otolaryngology-Head and Neck Surgery, The Key Laboratory of Advanced Interdisciplinary Studies Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
⁴⁸ Department of Thoracic Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China.
⁴⁹ Department of Thoracic Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
⁵⁰ Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China.
⁵¹ Department of Thoracic Surgery, Meizhou People's Hospital, Meizhou, China.
⁵² Department of Thoracic Surgery, St. James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
⁵³ Division of Thoracic Surgery, Department of Visceral, Thoracic and Vascular Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
⁵⁴ Department of Thoracic Surgery, Fachkrankenhaus Coswig, Coswig, Germany.
⁵⁵ Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy.
⁵⁶ Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
⁵⁷ Department of Cardiac, Thoracic, and Vascular Surgery, National University Heart Centre Singapore, Singapore, Singapore.
⁵⁸ Division of Thoracic Surgery, Department of Surgery, Houston Methodist Hospital, Houston, TX, USA.
⁵⁹ Department of Thoracic Surgery, Ospedali Riuniti delle Marche, Ancona, Italy.
⁶⁰ Department of Thoracic Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
⁶¹ Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA.
⁶² Thoracic Surgery Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.
⁶³ Department of Cardiothoracic Surgery, Allegheny General Hospital, Pittsburgh, PA, USA.
⁶⁴ Division of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
⁶⁵ Department of Thoracic Surgery, Hirslanden Clinic Beau Site, Bern, Switzerland.
⁶⁶ Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.
⁶⁷ Thoracic Surgery Unit-IRCCS Humanitas Research Hospital, Rozzano, Italy.
⁶⁸ Thoracic Surgery Department, University Clinical Hospital of Valladolid, University of Valladolid, Valladolid, Spain.
⁶⁹ Division of Thoracic Surgery, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella, Italy.
⁷⁰ Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
⁷¹ Thoracic Surgery Department, Clínica Universidad de Navarra, Madrid, Spain.
⁷² Department of Cardiothoracic Surgery, Manchester University Hospital Foundation Trust, Wythenshawe Hospital, Manchester, UK.

PMID: 40386733
PMCID: PMC12082217
DOI: 10.21037/tlcr-2025-273

Abstract

Background: Perioperative airway management is critical for patient safety and optimal surgical outcomes. Effective airway management reduces postoperative pulmonary complications and accelerates recovery. This expert consensus aims to update the earlier consensus based on the latest research and emphasize aspects that were previously overlooked.

Methods: A comprehensive search up to June 2024 was performed. Earlier consensus documents were reviewed to ensure thorough coverage. A modified Delphi method involved 62 domestic experts from various surgical and anesthetic specialties who discussed and voted on preliminary recommendations in face-to-face meetings, requiring ≥70% agreement. Drafts were then reviewed by 18 international experts via email to incorporate diverse insights.

Results: Through the modified Delphi method, consensus was achieved with ≥70% agreement among the 62 domestic experts, ensuring that the preliminary recommendations were robust and widely supported. Additionally, feedback from the 18 international experts provided diverse insights that further refined and validated the recommendations. Recommendations were established for preoperative airway preparation, anesthesia management, surgical approach, postoperative airway management, and managing coexisting respiratory diseases. These recommendations update the perspectives of earlier consensus documents based on the latest research and emphasize non-intubated surgery, inhalation therapy, and individualized treatment for patients with coexisting pulmonary diseases.

Conclusions: This expert consensus provides a valuable reference for clinical practice. Further technological optimization and clinical research are needed to improve perioperative airway management.

Keywords: Perioperative airway management; anesthesia; coexisting pulmonary disease; inhalation therapy; non-intubated surgery.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tlcr.amegroups.com/article/view/10.21037/tlcr-2025-273/coif). Maria Rodriguez reports consulting fees and payment for lectures/activities from AstraZeneca, Abex/Intuitive and Johnson and Johnson. The other authors have no conflicts of interest to declare.

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Multidisciplinary international expert consensus on perioperative airway management

Affiliations

Multidisciplinary international expert consensus on perioperative airway management

Authors

Affiliations

Abstract

Conflict of interest statement

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