ASA Guidelines for Management of Difficult Airway

ASA Guidelines for Management of the Difficult Airway from Sun YaiCheng

Practice Guidelines for Management of the Difficult Airway

An Updated Report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway 

Anesthesiology 2013; 118(2):251-270

Difficult Airway

• Difficult Ventilation
• Difficult Intubation 

Evaluation of the Airway

• History
• Physical Examination
• Image

Basic Preparation for Difficult Airway Management

1. Informing the patient with a known or suspected difficult airway
2. Availability of equipment for management of a difficult airway (i.e., a portable storage unit)
3. Availability of an assigned individual to provide assistance when a difficult airway is encountered
4. Preanesthetic preoxygenation by facemask before induction of anesthesia

Strategy for Intubation of the Difficult Airway

• Awake intubation
• Video-assisted laryngoscopy
• Intubating stylets or tube-changers
• SGA for ventilation (e.g., LMA, laryngeal tube)
• SGA for intubation (e.g., ILMA)
• Rigid laryngoscopic blades of varying design and size
• Fiberoptic-guided intubation
• Lighted stylets or light wands

The identification of a primary or preferred approach to:

1. Awake intubation
2. Patient can be adequately ventilated but is difficult to intubate
3. Life-threatening situation: the patient cannot be ventilated or intubated

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【摘要】 Difficult Airway 處置 ﹝2013 ASA Guideline﹞

評估：Hx, PE, Image

Difficult Airway：通氣困難？或 插管困難？.

準備：

1. 告知病患/關係人 及 醫療團隊人員
2. 準備困難插管組套
3. 指定一人擔任困難插管助手
4. 插管(麻醉)前, 持續給足氧氣

確認狀況 選擇方案

1. Awake intubation
2. Non-Emergency ：可通氣 但 困難插管
3. Emergency ：通氣不良 且 插管失敗