Management of the anticipated difficult airway.

The protocol dictated the use of a gum elastic bougie (GEB) for intubation difficulty, followed by insertion of an intubating laryngeal mask airway (ILMA) if intubation was still not successful. Intubation difficulty was defined as two failed laryngoscopy attempts by a senior physician using optimal laryngeal manipulation. For difficult ventilation, the protocol recommended ILMA insertion followed, if necessary, by percutaneous transtracheal jet ventilation. Difficult ventilation was defined as an inability to maintain oxygen saturation over 90%, need for a twohanded mask technique, excessive mask leak, or no chest rise.