Difficult airway guidelines
- 1. Unanticipated difficult tracheal intubation- during routine induction of anaesthesia in an adult patient Direct Any Call laryngoscopy problems for help Plan A: Initial tracheal intubation plan Direct laryngoscopy - check: Neck flexion and head extension Laryngoscope technique and vector Not more External laryngeal manipulation - than 4 attempts, succeed maintaining: Tracheal intubation by laryngoscopist (1) oxygenation Vocal cords open and immobile with face mask and If poor view: Introducer (bougie) - (2) anaesthesia seek clicks or hold-up Verify tracheal intubation and/or Alternative laryngoscope (1) Visual, if possible (2) Capnograph failed intubation (3) Oesophageal detector "If in doubt, take it out" Plan B: Secondary tracheal intubation plan Confirm: ventilation, oxygenation, ILMATM or LMATM anaesthesia, CVS stability and muscle Not more than 2 insertions succeed relaxation - then fibreoptic tracheal intubation Oxygenate and ventilate through IMLATM or LMATM - 1 attempt If LMATM, consider long flexometallic,nasal failed oxygenation RAE or microlaryngeal tube (e.g. SpO2 < 90% with FiO2 1.0) Verify intubation and proceed with surgery via ILMATM or LMATM failed intubation via ILMATM or LMATM Plan C: Maintenance of oxygenation, ventilation, postponement of surgery and awakening Revert to face mask Oxygenate and ventilate Reverse non-depolarising relaxant succeed Postpone surgery 1 or 2 person mask technique Awaken patient (with oral ± nasal airway) failed ventilation and oxygenation Plan D: Rescue techniques for "can't intubate, can't ventilate" situation Difficult Airway Society Guidelines Flow-chart 2004 (use with DAS guidelines paper)