Airway Management in Anesthesia

Devices and Techniques

The American Society of Anesthesiologists (ASA) recommends the use of face masks, supraglottic airways (SGAs), and endotracheal tubes for airway management, with videolaryngoscopy considered superior to direct laryngoscopy for difficult airways 1, 2
Face masks provide basic ventilation and oxygenation, serving as the first-line device for preoxygenation and initial airway management 2, 3
Supraglottic airways (SGAs) offer intermediate airway control without tracheal intubation, with second-generation devices providing superior airway seal and reduced aerosol generation 4, 5
Endotracheal tubes provide definitive airway control with cuff inflation to 20-30 cmH₂O pressure for optimal seal 4
Videolaryngoscopes demonstrate 92-100% success rates for rescue intubation after failed direct laryngoscopy in emergency difficult airways 6

The ASA recommends the use of bougies as the primary adjunct for difficult airways, with a demonstrated superior first-attempt success rate of 96% compared to stylets 6
Introducers and bougies facilitate tube passage when glottic visualization is limited, with documented 96% first-attempt success in emergency departments 6
Stylets provide tube rigidity and shape control, achieving 82% first-attempt success 6
Airway exchange catheters enable tube exchange while maintaining airway access and can provide emergency ventilation with expiratory ventilation assistance 6

The ASA algorithm structures management into four distinct scenarios: awake intubation, adequate ventilation with difficult intubation, cannot ventilate/cannot intubate, and emergency invasive rescue 1, 2, 9, 4
The ASA recommends evaluating multiple anatomical features in combination to predict difficult airway, including Mallampati score, thyromental distance, and neck circumference 1, 2, 4
The ASA recommends ensuring immediate equipment availability, including airway management equipment in the room and a portable difficult airway cart 2, 3, 4

The ASA recommends the use of capnography or end-tidal CO₂ monitoring to confirm tracheal intubation, with a reduction in adverse outcomes 1, 2, 8, 3
Continuous waveform capnography provides real-time confirmation and is preferred over auscultation 8, 3, 4

The ASA recommends monitoring according to ASA standards throughout the procedure, including assessment of signs of inadequate ventilation 7
The ASA recommends providing supplemental oxygen via nasal cannulae, facemask, or SGA insufflation during airway management 7

The ASA recommends awake extubation to reduce airway-related adverse outcomes, with verification of adequate spontaneous ventilation and oxygenation 8, 3
The ASA recommends suctioning the oropharynx before cuff deflation and providing supplemental oxygen immediately after extubation 8, 3

The ASA recommends documenting the nature of airway difficulty, techniques used, and communicating this to the patient and future providers 8, 3, 4
The ASA recommends recording the difficult airway plan prominently and displaying it visibly on the patient's chart 4
The ASA recommends communicating the plan to staff at shift changeovers to ensure continuity 4