Much has been written in the last half century on the "difficult airway". Usually this term is applied to a patient who is currently using the very same airway with success. More precisely what the anesthesia care provider often means is that difficulty is anticipated in placing an endotracheal tube. Isn't this label a bit ego-centric? The patient is probably less interested in our "difficulty" and more interested in being safely maintained - in this circumstance ventilated and oxygenated adequately. The factors contributing to difficulty in ventilation with induction of general anesthesia have been less studied by our specialty than factors contributing to difficult endotracheal tube placement. Our colleagues investigating sleep apnea have, however, provided much of the recent literature on upper airway function during altered consciousness.
With the proliferation of endotracheal intubation aids with excellent optics a substantial armamentarium now exists to counter challenging intubation scenarios. Perhaps it is time to become more patient-centric and emphasize assessment of the airway and pulmonary system with respect to satisfactory ventilation after induction of anesthesia, intraoperatively, and postoperatively. Fortunately, there has also been a proliferation of hypopharyngeal ventilatory devices such as the laryngeal mask airway that offer immediate assistance with difficult ventilation while the optimal talent, strategy, and devices are chosen for successful intubation.
David G Bjoraker, MD
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