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Difficult airway management in an ambulatory surgical center?

Greenland, Keith B.

Current Opinion in Anesthesiology: December 2012 - Volume 25 - Issue 6 - p 659–664
doi: 10.1097/ACO.0b013e3283593163
AMBULATORY ANESTHESIA: Edited by J. Lance Lichtor

Purpose of review This review will focus on two key aspects of difficult airway management in an ambulatory surgical center (ASC). First, the selection process of patients with known difficult airways suitable for this environment, and second, the requirements of a difficult airway cart to manage unexpected airway problems.

Recent findings The decision whether to manage a patient with a previously documented difficult airways in an ASC requires a multidisciplinary approach. Many factors will influence this decision including the cause and severity of the airway problem, the type of procedure, the experience of the perioperative staff, and the availability of difficult airway management devices.

Unexpected difficult airways will always occur in anesthesia. Difficult airway carts are, therefore, a requirement for any area in which anesthesia is to be conducted. The contents of these carts should reflect the need to maintain patient oxygenation to avoid morbidity and mortality. Regular training sessions should include both technical training in the use of equipment and nontechnical training to improve interpersonal communication during crises.

Summary The management of ambulatory surgical practices must provide suitable difficult airway management equipment as well as technical and nontechnical training. Patients may present to an ASC with expected and unexpected difficult airways. Appropriate management of these patients requires advance planning to avoid poor outcomes.

Department of Anaesthesiology, Queen Mary Hospital, University of Hong Kong, Pokfulam, Hong Kong

Correspondence to Doctor Keith B. Greenland, MBBS, MD, FANZCA, FHKAM, Associate Professor, Department of Anaesthesiology, Queen Mary Hospital, University of Hong Kong, Room 424 K Block, Pokfulam Road, Hong Kong. E-mail:

© 2012 Lippincott Williams & Wilkins, Inc.