11 - Managing difficult intubations

Summary

Key learning points

• Available aids and techniques for both predicted and unexpected failed or difficult intubations

• The importance of preoperative airway assessment and its impact on induction

Introduction

As the anaesthetic assistant's role develops, with opportunities arising for some to become non-medical anaesthetists (anaesthesia practitioner), preoperative assessments are already being carried out by anaesthetic assistants in a number of hospitals. This chapter aims to outline the prediction and management of difficult intubations for the participant, be it junior anaesthetist, non-medical anaesthetist or anaesthetic assistant. For those who will not be assessing or managing difficult airways, this chapter will provide valuable insight and enable the anaesthetic assistant to anticipate the needs of the anaesthetist.

A preoperative visit from the anaesthetist is appreciated by patients and has been shown to be more effective in reducing anxiety than premedication. The aim of the preoperative assessment is to ensure the patient's health is optimal and any potential difficulties during anaesthesia are anticipated. In the United Kingdom, it has traditionally been the role of the anaesthetist to perform the assessment of the airway and subsequent procedure of intubation for elective surgery, although no test is 100% reliable in predicting difficult intubation.

A history of previous difficult intubation is important, but a history of straightforward intubation some years earlier may be falsely reassuring. Whether we like it or not, we all change physically with age; increasing weight, reduced spinal flexion or changing disease processes means possible implications for airway management.