I
nstead of visualizing the vocal cords, all I could see was pink and
froth. Now what? That easy intubation just got a lot more inter-
esting and a lot more challenging on the young male patient with
the facial tumor. Thankfully, over my 42-year career in the OR, I
had taken the time and effort to master the tools of difficult air-
way management. I set aside my laryngoscope and blade and reached
into my difficult airway cart for my fiberoptic bronchoscope (this was
before the advent of video laryngoscopes). Crisis averted. But only
because I had learned this critical lesson about difficult airways:
Better to prepare for challenging intubations than to (try to) predict
them or, worse yet, foolishly think that one won't happen to you.
Our worst nightmare
The unanticipated difficult airway is an anesthesia provider's worst
nightmare. It shows up without warning, rarely announcing itself in
the form of an obese patient with limited head extension and obvious
airway pathology. What if you can't visualize vocal cords? What if the
patient starts desaturating?
We're fortunate that we can stock our airway carts with such new
and advanced (and affordable!) tools as video laryngoscopes and dis-
4 3
A P R I L 2 0 1 5 | O U T P A T I E N T S U R G E R Y . N E T
Once a month, set aside a
day to master the tools of
difficult airway management
on routine, healthy patients
who have normal airways.
