Difficult Airway Algorithm

a. Other options include (but are not limited to): surgery utilizing face mask or supraglottic airway (SGA) anesthesia (e.g., LMA(laryngeal mask), ILMA (intubating laryngeal mask), laryngeal tube), local anesthesia infiltration or regional nerve blockade. Pursuit of these options usually implies that mask ventilation will not be problematic.

Therefore, these options may be of limited value if this step in the algorithm has been reached via the Emergency Pathway.

b. Invasive airway access includes surgical or percutaneous airway, jet ventilation, and retrograde intubation.

c. Alternative difficult intubation approaches include (but are not limited to): video-assisted laryngoscopy, alternative laryngoscope blades, SGA (e.g., LMA or ILMA) as an intubation conduit (with or without fiberoptic guidance), fiberoptic intubation, intubating stylet or tube changer, light wand, and blind oral or nasal intubation.

d. Consider re-preparation of the patient for awake intubation or canceling surgery.

e. Emergency non-invasive airway ventilation consists of a SGA.

*Confirm ventilation, tracheal intubation, or SGA placement with exhaled CO2.

Source: Practice Guidelines for Management of the Difficult Airway An Updated Report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway

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