Article of the Month, May 2022

Dear friends, airway enthusiasts,

I would like to propose to read two new published articles :

1. A Decision Tree Approach to Airway Management Pathways in the 2022 Difficult Airway Algorithm of the American Society of Anesthesiologists by William Rosenblatt (first author) published in Anesthesia and Analgesia and

2. The physiologically difficult airway: an emerging concept by Sheila Myatra (the first author) published in Current Opinion of Anaesthesiology.

The first article presents a new decision tree tool that uses inductive assessments to guide the anaesthesiologist’s choice of pathway in the ASA’s Difficult Airway Algorithm developed by The American Society of Anaesthesiologists’ (ASA) Task Force on Management of the Difficult Airway. The tool help out the anaesthesiologist to consider the risk of difficulty with laryngoscopy (direct or indirect) and tracheal intubation, facemask or supraglottic ventilation, gastric contents aspiration and rapid oxyhaemoglobin desaturation to make a plan and take the right decision for airway management. The decision integrates the anaesthesiologist’s combination of experience, expertise, patient anatomy and disease, equipment availability, and other contextual conditions into the decision process. The endpoint is the choice of awake intubation versus airway management after the induction of general anaesthesia as a fundamental element of the ASA Difficult Airway Algorithm.

The second article will further present the physiologically difficult airway as an emerging concept, in fact the situations defined in previous article such as low tolerable apnoea time with rapid oxyhaemoglobin desaturation. The concept is referring to patients that are not mandatory anatomically difficult’ but the physiologic derangements due to acute illness, pre- existing disease, the effects of anaesthetic agents or positive pressure ventilation can result in severe cardiopulmonary complications, such as cardiovascular collapse or death, during tracheal intubation. This risk is especially recognized in critically ill, obese, pregnant, or paediatric patients

Hope you will enjoy! Stay safe and see you in Milan!

Daniela Godoroja-Diarto