Education  |   May 2019
Preparation for and Management of “Failed” Laryngoscopy and/or Intubation
Author Notes
  • From the Department of Anesthesia, Faculty of Medicine, University of Toronto and University Health Network, Toronto General Hospital, Toronto, Ontario, Canada.
  • This article is featured in “This Month in Anesthesiology,” page 1A.
    This article is featured in “This Month in Anesthesiology,” page 1A.×
  • Submitted for publication March 8, 2018. Accepted for publication November 7, 2018.
    Submitted for publication March 8, 2018. Accepted for publication November 7, 2018.×
  • Address correspondence to Dr. Cooper: University of Toronto and University Health Network, Toronto General Hospital, 200 Elizabeth St. 3EN-421, Toronto, Ontario M5G 2C4, Canada. richard.cooper@utoronto.ca. 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
Education / Review Article / Airway Management / Respiratory System
Education   |   May 2019
Preparation for and Management of “Failed” Laryngoscopy and/or Intubation
Anesthesiology 5 2019, Vol.130, 833-849. doi:10.1097/ALN.0000000000002555
Anesthesiology 5 2019, Vol.130, 833-849. doi:10.1097/ALN.0000000000002555
Abstract

An airway manager’s primary objective is to provide a path to oxygenation. This can be achieved by means of a facemask, a supraglottic airway, or a tracheal tube. If one method fails, an alternative approach may avert hypoxia. We cannot always predict the difficulties with each of the methods, but these difficulties may be overcome by an alternative technique. Each unsuccessful attempt to maintain oxygenation is time lost and may incrementally increase the risk of hypoxia, trauma, and airway obstruction necessitating a surgical airway. We should strive to optimize each effort. Differentiation between failed laryngoscopy and failed intubation is important because the solutions differ. Failed facemask ventilation may be easily managed with an supraglottic airway or alternatively tracheal intubation. When alveolar ventilation cannot be achieved by facemask, supraglottic airway, or tracheal intubation, every anesthesiologist should be prepared to perform an emergency surgical airway to avert disaster.