Anticipated and Unanticipated Difficult Airway: A Practical and Logical Approach; A Narrative Review

Stability of the airway is a fundamental element of acute care medical practice. While airway management is conceptually straightforward, the wide variety of clinical circumstances, patients, and tools can make the task of ensuring a stable, open airway under all clinical conditions extremely challenging. Care providers involved in airway management must therefore not only be technically skilled but also sufficiently flexible to adjust changing the conditions, risk/benefit balances, and goals. One aspect of airway management that requires particular attention is the airway that is difficult to secure or keep patent. For clinical or anatomic reasons, both bag mask ventilation and tracheal intubation in such a patient population may be difficult without specialized expertise or tools. Because adequate oxygen delivery through a patent airway is critical to life support and resuscitative efforts, the risks of inadequate airway management are high, adding to the challenge. One significant advance in difficult airway management is the development of algorithms to standardize the technical approach to successful endotracheal intubation in a patient with a difficult airway. Such algorithms are relatively recent (The American Society of Anesthesiologists difficult airway algorithm updated in 2015), and integrate clinical experience, evidence, and technical expertise into a stepwise approach to anticipated and unanticipated airway challenges.