Newly Published
SPECIAL ARTICLE  |   March 2019
An Anesthesiologist’s Perspective on the History of Basic Airway Management: The “Modern” Era, 1960 to Present
Author Notes
  • From the Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin.
  • Submitted for publication March 13, 2018. Accepted for publication August 30, 2018.
    Submitted for publication March 13, 2018. Accepted for publication August 30, 2018.×
  • Correspondence: Address correspondence to Dr. Matioc: William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Room A8030, Madison, Wisconsin 53705. tmatioc@gmail.com. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Airway Management / Respiratory System
SPECIAL ARTICLE   |   March 2019
An Anesthesiologist’s Perspective on the History of Basic Airway Management: The “Modern” Era, 1960 to Present
Anesthesiology Newly Published on March 1, 2019. doi:10.1097/ALN.0000000000002646
Anesthesiology Newly Published on March 1, 2019. doi:10.1097/ALN.0000000000002646
Abstract

This fourth and last installment of my history of basic airway management discusses the current (i.e., “modern”) era of anesthesia and resuscitation, from 1960 to the present. These years were notable for the implementation of intermittent positive pressure ventilation inside and outside the operating room. Basic airway management in cardiopulmonary resuscitation (i.e., expired air ventilation) was de-emphasized, as the “A-B-C” (airway-breathing-circulation) protocol was replaced with the “C-A-B” (circulation-airway-breathing) intervention sequence. Basic airway management in the operating room (i.e., face-mask ventilation) lost its predominant position to advanced airway management, as balanced anesthesia replaced inhalation anesthesia. The one-hand, generic face-mask ventilation technique was inherited from the progressive era. In the new context of providing intermittent positive pressure ventilation, the generic technique generated an underpowered grip with a less effective seal and an unspecified airway maneuver. The significant advancement that had been made in understanding the pathophysiology of upper airway obstruction was thus poorly translated into practice. In contrast to consistent progress in advanced airway management, progress in basic airway techniques and devices stagnated.