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• W179997888 abstract "Airway difficulties are probably the most dreaded complications in anesthesia. In contrast with most other adverse effects seen in our practice, the initial physical status of the patient has little to do with the risk associated with airway management. An otherwise healthy individual is just as likely as an American Society of Anesthesiologists class IV patient to suffer severe, if not lethal, consequences of poor oxygenation. In a much needed attempt to provide practicing anesthesiologists with safer and more effective methods, there has been an explosion of intubation tools and other airway devices during the past two decades or so. With this proliferation of technological aids, there arose a need to reactivate the Canadian Airway Focus Group, which produced its latest recommendations in 1998. Currently, the Group is made up of 14 airway experts from across Canada, four of whom were members of the original committee. In this issue of the Journal, the Group proposes a set of recommendations designed for two different contexts, the unanticipated difficult intubation and the anticipated difficult airway. Contrary to what could have been expected, the Group did not recommend a given device or a specific method when approaching the difficult airway, which will probably be a disappointment for those who like simple recipes. In spite of, and probably because of, the multiplicity of new tools and approaches, safe airway management is not simpler than it was in the past. Paradoxically, the emphasis is no longer on tools and devices but rather on good planning and communication. In terms of specific recommendations, the reader might notice the relatively low level of evidence on which they are based, as most have received a C rating. According to the authors’ definition, a C rating signifies a low level of evidence. This reflects the real difficulty in obtaining hard data on difficult airway management, as this challenging situation is rather uncommon. Still, a few take-home messages emerge from the Group recommendations, and a few key points need to be emphasized. First, maintaining oxygenation has been put forward as the ultimate goal of all the airway maneuvers. The commonly used acronym, CICV (cannot intubate cannot ventilate), has been replaced with CICO (cannot intubate cannot oxygenate). This is not just a matter of semantics. Oxygen stores can be optimized by careful preoxygenation and/or provided passively by a number of methods. The recommended course of action in a given situation depends heavily on whether oxygen saturation is maintained in the process of attempting to secure the airway. Second, in spite of the increasing popularity and widespread use of supraglottic devices (SGDs), tracheal intubation remains the gold standard for and preferred method of definitive airway management. Still, SGDs can play a role as rescue devices if tracheal intubation becomes difficult or impossible, even in obstetrics. Also, in the anticipated difficult intubation scenario, the authors mention that induction of anesthesia and an attempt at tracheal intubation can be justified if there are good reasons to believe that insertion of a SGD would be successful as a fallback measure. The authors do not recommend a specific device or method of insertion. In the first article, Fig. 1 Plan B calls for an ‘‘alternative device’’ or a ‘‘different operator’’. The authors insist that the key element is the skill and familiarity of that particular operator with the particular device. F. Donati, MD, PhD (&) Department of Anesthesiology, Hopital Maisonneuve-Rosemont and Universite de Montreal, 5415, boul. l’Assomption, Montreal, QC H1T 2M4, Canada e-mail: francois.donati@umontreal.ca" @default.
• W179997888 created "2016-06-24" @default.
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• W179997888 date "2013-09-21" @default.
• W179997888 modified "2023-10-12" @default.
• W179997888 title "Airway management: judgment and communication more than gadgets" @default.
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• W179997888 doi "https://doi.org/10.1007/s12630-013-0029-1" @default.
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