Airway management

We have made remarkable advances in techniques to secure a patent airway, and have developed new equipment and methods to monitor breathing. Yet, respiratory complications remain the leading cause of anesthesia-related deaths, with the majority related to failure to obtain control of the airway. Here we will discuss: (i) how to evaluate the airway of a patient; (ii) the impact of the planned procedure designed to protect the airway; and (iii) how to manage the airway. First, let us explain why all this matters.

Any time we anesthetize a patient, we must be prepared to take over his ven-tilation at a moment’s (or less) notice because anesthesia can interfere with the patient’s ventilation in so many ways. We may have weakened, with muscle relax-ants, the patient’s ability to breathe. We may have put him into a deep coma, anesthetizing his respiratory center and relaxing the muscles in his mouth and pharynx so that his air passage is obstructed. We might have suppressed his urge to breathe with hypnotics and narcotics during nothing more than a minor sur-gical procedure. Whatever the roots of the failure to breathe, we must be ready to ventilate the patient’s lungs, which means establishing or re-establishing a patent airway and, if necessary, breathing for the patient.

Therefore, before anesthetizing any patient, we examine the airway, looking for physical findings that can be reassuring or worrisome.