Difficulties with airway management (AM) during induction and maintenance of general anesthesia (GA) and emergence from GA may result in injuries with severe morbidity and mortality (23 28, 42). Most of these adverse events are preventable, provided that a strategy for difficult airway (DA) management is followed, equipment and assistance are available, and the operator is skilled with different devices and techniques of AM (30).
Expert working groups have developed guidelines and recommendations for the management of the DA. The American Society of Anesthesiologists guidelines, first published in 1993 (1), was a landmark publication; an update of these guideline followed in 2003 (2). The group in France published their expertise in 1996 (10), the Canadian group in 1998 (22), the Italian group in 1998 [(27), updated in 2005 (43)], the British group in 2004 (32), and the German group in 2004 (11). Furthermore, there are two prospective single-institution studies from Switzerland (31) and France (18) using different strategies for the management of the DA.
The results of a survey questionnaire in regard to AM behavior and adherance to published guidelines and recommendations for DA management, including all anesthesia departments in Austria (47), were considered by our working group to formulate these recommendations. We studied published guidelines and recommendations and evaluated strategies for the management of the DA; furthermore, we reviewed the current literature with emphasis on preparatory provisions and evaluated backup devices applied for DA management. Based on these reviews and available evidence, we generated these recommendations, primarily intended for adult patients, in order to assist the Austrian anesthesia community in decision-making and formulating departmental strategies, specifically taking into account national preferences and equipment availability. The nationwide implementation of preformulated and practiced departmental strategies for the management of the unanticipated DA and the management of difficult tracheal extubation may improve patient care and prevent adverse outcomes associated with inadequate or failed airway access.
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