Airway management: contents of a difficult intubation cart.

Abstract

D ESPITE our extensive clinical experience, anesthesiologists still encounter unexpected difficult intubations. We need to be prepared with an organized plan such as the ASA algorithm ~s for management of the difficult airway. In a can't intubate/can't ventilate situation, emergency methods of oxygenation and ventilation must be rapidly available. There are many anecdotal reports of intubating 'tricks'. The ASA task force 2 and a recent review 4 recommend the general types of equipment that should be stocked on a difficult intubation kit. There are commercially available trays specifically designed for certain aspects of airway management. In a university teaching hospital department, we found it necessary to organize a comprehensive difficult intubation cart due to the preferences of different anesthesiologists. Since we do not practice pediatric anesthesia, our intubation cart is designed for adult patients. There is one clearly labeled difficult intubation cart in the operating room area and two portable kit bags. Adult and pediatric fiberoptic bronchoscopes and the BuUard laryngoscope are stored on a separate portable cart. Our purpose is not to mention all possible airway management equipment. We hope this listing will help others formulate and organize their own difficult intubation cart. It is important that anesthesiologists and trainees be familiar with the indications and limitations of these devices. Having previously thought through the steps of emergency airway management and with the equipment readily available, the anesthesiologist will be better prepared to deal efficiently with difficult airway situations. Equipment for airway management and intubation: