naa a22 4500 51074477X CHVBK 20180411092755.0 cr unu---uuuuu 180411e20131101xx s 000 0 eng 10.1007/s12630-013-0020-x doi (NATIONALLICENCE)springer-10.1007/s12630-013-0020-x The difficult airway with recommendations for management - Part 2 - The anticipated difficult airway [Elektronische Daten] [J. Law, Natasha Broemling, Richard Cooper, Pierre Drolet, Laura Duggan, Donald Griesdale, Orlando Hung, Philip Jones, George Kovacs, Simon Massey, Ian Morris, Timothy Mullen, Michael Murphy, Roanne Preston, Viren Naik, Jeanette Scott, Shean Stacey, Timothy Turkstra, David Wong] Prise en charge des voies aériennes - 2e partie - Recommandations lorsque des difficultés sont prévues Background: Appropriate planning is crucial to avoid morbidity and mortality when difficulty is anticipated with airway management. Many guidelines developed by national societies have focused on management of difficulty encountered in the unconscious patient; however, little guidance appears in the literature on how best to approach the patient with an anticipated difficult airway. Methods: To review this and other subjects, the Canadian Airway Focus Group (CAFG) was re-formed. With representation from anesthesiology, emergency medicine, and critical care, CAFG members were assigned topics for review. As literature reviews were completed, results were presented and discussed during teleconferences and two face-to-face meetings. When appropriate, evidence- or consensus-based recommendations were made, and levels of evidence were assigned. Principal findings: Previously published predictors of difficult direct laryngoscopy are widely known. More recent studies report predictors of difficult face mask ventilation, video laryngoscopy, use of a supraglottic device, and cricothyrotomy. All are important facets of a complete airway evaluation and must be considered when difficulty is anticipated with airway management. Many studies now document the increasing patient morbidity that occurs with multiple attempts at tracheal intubation. Therefore, when difficulty is anticipated, tracheal intubation after induction of general anesthesia should be considered only when success with the chosen device(s) can be predicted in a maximum of three attempts. Concomitant predicted difficulty using oxygenation by face mask or supraglottic device ventilation as a fallback makes an awake approach advisable. Contextual issues, such as patient cooperation, availability of additional skilled help, and the clinician's experience, must also be considered in deciding the appropriate strategy. Conclusions: With an appropriate airway evaluation and consideration of relevant contextual issues, a rational decision can be made on whether an awake approach to tracheal intubation will maximize patient safety or if airway management can safely proceed after induction of general anesthesia. With predicted difficulty, close attention should be paid to details of implementing the chosen approach. This should include having a plan in case of the failure of tracheal intubation or patient oxygenation. The Author(s), 2013 Law J. Department of Anesthesia, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax Infirmary Site, 1796 Summer Street, B3H 3A7, Halifax, NS, Canada aut Broemling Natasha aut Cooper Richard aut Drolet Pierre aut Duggan Laura aut Griesdale Donald aut Hung Orlando aut Jones Philip aut Kovacs George aut Massey Simon aut Morris Ian aut Mullen Timothy aut Murphy Michael aut Preston Roanne aut Naik Viren aut Scott Jeanette aut Stacey Shean aut Turkstra Timothy aut Wong David aut Canadian Journal of Anesthesia/Journal canadien d'anesthésie Springer US; http://www.springer-ny.com 60/11(2013-11-01), 1119-1138 0832-610X 60:11<1119 2013 60 12630 https://doi.org/10.1007/s12630-013-0020-x text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s12630-013-0020-x text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Law J. Department of Anesthesia, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax Infirmary Site, 1796 Summer Street, B3H 3A7, Halifax, NS, Canada aut NATIONALLICENCE 700 1- Broemling Natasha aut NATIONALLICENCE 700 1- Cooper Richard aut NATIONALLICENCE 700 1- Drolet Pierre aut NATIONALLICENCE 700 1- Duggan Laura aut NATIONALLICENCE 700 1- Griesdale Donald aut NATIONALLICENCE 700 1- Hung Orlando aut NATIONALLICENCE 700 1- Jones Philip aut NATIONALLICENCE 700 1- Kovacs George aut NATIONALLICENCE 700 1- Massey Simon aut NATIONALLICENCE 700 1- Morris Ian aut NATIONALLICENCE 700 1- Mullen Timothy aut NATIONALLICENCE 700 1- Murphy Michael aut NATIONALLICENCE 700 1- Preston Roanne aut NATIONALLICENCE 700 1- Naik Viren aut NATIONALLICENCE 700 1- Scott Jeanette aut NATIONALLICENCE 700 1- Stacey Shean aut NATIONALLICENCE 700 1- Turkstra Timothy aut NATIONALLICENCE 700 1- Wong David aut NATIONALLICENCE 773 0- Canadian Journal of Anesthesia/Journal canadien d'anesthésie Springer US; http://www.springer-ny.com 60/11(2013-11-01), 1119-1138 0832-610X 60:11<1119 2013 60 12630 Metadata rights reserved Springer special CC-BY-NC licence nationallicence SWISSBIB 510744699 BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer