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Featured Articles: Infographic

Decision Making in the Difficult Airway Algorithm

Nathan, Naveen MD

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doi: 10.1213/ANE.0000000000006004
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Anesthesiologists are quite familiar with the American Society of Anesthesiologists (ASA) Difficult Airway Algorithm (DAA). Developed in the 1990s, this algorithm classically separated the management of tracheal intubation into the awake pathway and after induction of general anesthesia. It has undergone several revisions since as advances in techniques and equipment entered the clinician’s arsenal over time. What was missing from the DAA were key elements of decision making that would guide the anesthesia care provider through the pathway. The ASA Task Force on Management of the Difficult Airway recently convened to address these gaps. The result is the 2022 update to the DAA which provides a decision tree tool consisting of critical questions to be asked by anesthesiologists during airway management. These include addressing whether or not the patient will be predictably challenging to intubate and/or noninvasively ventilate, whether they pose a significant aspiration risk, and their tolerance of apneic time. Additionally, the task force incorporated the unique variables that may have significant impact on airway management. The clinician’s experience and skill set, the patient’s unique clinical context and level of cooperation, and available resources are all emphasized as seen in this infographic. The reader is encouraged to review the cited article for a full scope of understanding of these concepts.

    REFERENCES

    1. Rosenblatt WH, Yanez ND. A decision tree approach to airway management pathways in the 2022 difficult airway algorithm of the American Society of Anesthesiologists A decision tree approach to airway management pathways in the 2022 difficult airway algorithm of the American Society of Anesthesiologists. Anesth Analg. 2022;134:910-915.
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