Features  |   September 2013
ASA Difficult Airway Management Guidelines: What’s New?
Article Information
Airway Management / Quality Improvement / Features
Features   |   September 2013
ASA Difficult Airway Management Guidelines: What’s New?
ASA Monitor 09 2013, Vol.77, 10-12.
ASA Monitor 09 2013, Vol.77, 10-12.
Management of the difficult airway remains one of the most relevant and challenging tasks for anesthesiologists. A major factor for this concern is the serious consequence of inadequate oxygenation and ventilation. Airway complications remain high on the list of categories in the ASA Closed Claims Database as a cause of death or permanent neurologic injury (Figure 1).1 
In a review of anesthesiology closed claims cases in 1990, the leading causes of respiratory-related complications were inadequate ventilation, esophageal intubation and difficult intubation.2  Although esophageal intubation has nearly disappeared with the adoption of end-tidal capnography, difficult intubation remains a concern and represented 27 percent of all adverse respiratory events in 1991-2007 (Figure 2).3  While inadequate oxygenation and ventilation has decreased in the operating room with the adoption of pulse oximetry as a standard for intraoperative monitoring,4  it has risen in non-operating room locations, secondary to over-sedation and inadequate monitoring of ventilation.5,6  Also of significance is that pulmonary aspiration is the third most common respiratory event following inadequate oxygenation ventilation and difficult intubation.1  The Fourth National Audit Project (NAP4) of the Royal College of Anesthetists and the Difficult Airway Society revealed aspiration of gastric contents as second only to failed intubation in frequency of reported adverse events during anesthesia in the United Kingdom.7 
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