Difficult Airway Management in Adults

Abstract

Introduction: The difficult airway and its alternative ways of management are a daily challenge. Possible complications include death, brain injuries, airway trauma and aspirations. Aim: The search of up-to-date and most widely used guidelines of airway evaluation and management as well as ventilation means in patients with difficult airway, in order to inform health professionals involved. Μethod: A thorough review of electronic databases Scopus, Heal-link, Pubmed was performed. The keywords used for searching were: difficult airway, management, intubation, and equipment. The library of the Health Sciences of Athens was used for searching printed material and journals. A time period limit was set, and articles published from January to December 2011 were included. Results: The incidence of difficult intubation is between 1% and 4%, while that of impossible intubation ranges from 0.05% to 0.03%. Information on congenital malformations, acquired or traumatic anatomic defects, previous intubation, individual predictors, and the combination of prognostic factors in risk assessment provide an indication of the difficult airway. The airway management algorithm by the American Society of Anesthesiologists is widely accepted and used. The most predictable and effective combination was found to be the Mallampati classification combined with thyromental distance. The established methods for managing difficult airway are: intubation by direct vision, intubation by indirect vision, blind intubation techniques, and alternative methods of ventilation. Conclusions: Current diagnostic methods and algorithms for difficult airway management are undoubtedly of great value. Further research in the Greek population could help adjust these methods and algorithms to the clinical practice.