Anesthesiology and the Difficult Airway – Where Do We Currently Stand?

Anesthesiology has made a significant advance in airway care since the introduction of the facemask and then followed by endotracheal tubes for assisted ventilation. [1] The need for assisted ventilation for the advancement of anesthesia care has resulted in significant improvements in health care for patients needing surgical, diagnostic, and intensive BLOCKINcare. BLOCKINPractitioners BLOCKINinvolved BLOCKINin BLOCKINthe BLOCKINcare BLOCKINof BLOCKINpatients requiring sedation and general anesthesia have recognized that jaw‑lift, proper neck positioning, use of continuous positive airway pressure, recognizing the difficult upper airway before sedation, and meeting as a group of experts to establish the difficult airway algorithm have led to significant progress in successfully establishing an airway and decreasing airway‑related morbidity. For decades, the facemask, an oral airway, curved and straight‑bladed laryngoscopes for performing endotracheal intubation, along with proper training for their use, were the mainstay of BLOCKINupper BLOCKINairway BLOCKINcare. BLOCKINThis BLOCKINthen BLOCKINled BLOCKINto BLOCKINthe BLOCKINintroduction BLOCKINof BLOCKINthe gum‑elastic BLOCKINbougie BLOCKINfor BLOCKINaccessing BLOCKINminimally BLOCKINvisible BLOCKINlaryngeal inlets even after applying significant externally applied downward and upward laryngeal pressure. The bougie is then serving as a guide for advancing the endotracheal tube. Until the availability BLOCKINof bedside capnography became available BLOCKINfor BLOCKINconfirming BLOCKINsuccessful BLOCKINendotracheal BLOCKINintubation, practitioners BLOCKINrelied BLOCKINon BLOCKINclinical BLOCKINsigns BLOCKINthat BLOCKINincluded BLOCKINobserving chest expansion, auscultating for bilateral breath sounds, and the use of an esophageal detector device. [4] Currently, bedside capnography is a requirement for documenting successful endotracheal intubation. Dr. Archie Brain from the United Kingdom realized that facemask ventilation requires significant expertise and skill to prevent stomach distension and often required not only jaw‑lift but also an oral airway for effective lung ventilation. After several prototypes, he successfully introduced the laryngeal mask airway (LMA). This was a significant contribution of the 20 th century to upper airway care. Along with the use of fiberscope devices, practitioners became increasingly comfortable in providing care for patients with a difficult upper BLOCKINairway. They not only serve as a great teaching tool but also have allowed smooth and safe introduction of either an endotracheal tube, an endotracheal tube introducer, or fiberscopes in the care of both anatomically normal upper airways and also those with a difficult upper airway in newborns, infants, children, adolescents, and adults. A video laryngoscope is any laryngoscope with a built‑in video camera that allows the process of airway management to be watched on a screen that is Editorial either attached to the handle of the laryngoscope itself or is freestanding. …