of basic management problems: difficulty with patient cooperation or consent;
TOOL TIME
Airway Cart
Essentials
UNPREDICTABLE AIRWAY If intubation isn't possible
without causing significant harm or risking airway
obstruction, the case should be cancelled.
H
Plan for problems
Your anesthesia providers should be
trained in the techniques and tools of diffi-
ave a difficult airway cart on hand
for patients with suspected airway problems, and immediately
available in the event an unpredictable diffi-
cult airway management (see "Airway
cult airway arises. This cart typically takes
Cart Essentials" on page 8) and think
the form of a portable storage unit that
about how to manage a difficult airway in
includes rigid laryngoscope blades, a rigid
advance. The first time they use a suprafiber-optic laryngoscope, a video laryngo-
glottic airway (SGA) or video-assisted
scope, and tracheal tubes of assorted sizes
laryngoscope device should be during a
and tube guides. Supgraglottic airways
routine case, not an emergency one.
such as a laryngeal mask airway or intubat-
Conduct ongoing drills and practice with
ing LMA should be included in the cart for
difficult airway techniques and scenarios.
non-invasive airway ventilation/intubation.
The algorithm in the new guidelines proThe cart should also include flexible fiber-
vides a useful flowchart with recommendoptic intubation equipment, retrograde intu-
ed steps. The non-exhaustive summary I
bation equipment, emergency invasive air-
can provide here comprises 3 main steps
way-access equipment and an exhaled CO2
(with a number of substeps).
detector.
First, the anesthesia provider should
— Robert Caplan, MD
assess the likelihood and clinical impact
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