Vlassakov, K. Anesthesiology News | Published online: 12th August 2016
Multimodal airway approaches are being designed as a response to unusual difficult airway cases. Perhaps it is time to consider including these approaches in difficult airway algorithms as a final step before resorting to surgical access.
Huge technological advances, an overwhelming plethora of devices with competitive costs, and their increased availability around the world have all enhanced the ability to manage the difficult airway, but have not eliminated the risk for failure. In fact, at times the gains seem modest compared with the effort and cost. Increased acuity, complex comorbidities, and improved survival of patients with challenging congenital or acquired airway anatomy all play important roles in assessing airway success.
In the 1980s and 1990s, the introduction to mass clinical practice of steadily improving flexible fiber-optic equipment resulted in significant advances in safety and likely decreased the need for surgical airway access. However, some limitations in the ability to intubate the trachea despite adequate visualization of the glottis were quickly described and conceptualized, with prescribed maneuvers to address the problem. Soon, combining supraglottic airway devices with flexible fiber-optic devices became a preferred method for difficult (asleep and awake) airway management techniques. The present variety of video-enhanced airway devices, such as video laryngoscopes and video stylets with fiber-optic and CCD (charge coupled device) and CMOS (complementary metal oxide semiconductor) image sensor technology, has brought further improvements in glottic visualization, but still cannot always guarantee successful passage of the endotracheal tube.
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