A I R W A Y
M A N A G E M E N T
way [SGA] device," rather
consider the merits and how
than older terminology, a
easily and effectively a video
move that highlights the
laryngoscope might be used
increased use and variety of
because, across the board,
these airway tools.
the ASA saw enthusiasm for
2. The algorithm also highlights
KEY ADDITION Anesthesia providers should consider the merits
of using video laryngoscopes, which have gained popularity in
recent years.
Important Updates to ASA Guidelines
the importance of thinking
consultants and experts, so
about the role and utility of the
the new guidelines call it out
SGA, and alternatives in cases
WHAT'S NEW
T
as a basic consideration in the
where such a device won't
approach to the difficult airway.
he 2013 update to the
from the previous version:
work (due to, for example,
American Society of
1. The new algorithm for pro-
abscess in the back of the
Anesthesiologists diffi-
this device from practitioners,
ceeding in the face of a diffi-
— Robert Caplan, MD
patient's throat).
cult airway guidelines (published
cult airway actually uses the
3. The final major addition is that
in 2004) contains 3 key changes
formal term "supraglottic air-
anesthesia providers should
ment are greater than the benefits of surgery, it's time to cancel the case — regardless of the tools you have on hand or
the algorithms you follow. The point at which this decision is
made can be any time before or during the surgery. You can
decide after examining and talking to the patient on the
Dr. Caplan (rob ert.caplan@vmmc.org) is an anesthesiologist at
Virginia Mason Medical Center in Seattle, Wash., and chaired the
American Society of Anesthesiologists Task Force on the Difficult
Airway.
Reference:
1. Peterson GN, Domino KB, Caplan RA, et al. Management of the
difficult airway: a closed claims analysis. Anesthesiology.
2005;103(1):33–39.
morning of surgery that the risks are too great, and reschedule or move the case elsewhere. Or it can be in the OR just
as the patient's on the cusp of surgery. If you're not going to
be able to intubate without causing significant harm or risking airway obstruction during the perioperative period, cancel the surgery before managing a difficult airway turns into
airway emergency. OSM
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