Difficult airway society 2015 guidelines for management of unanticipated difficult intubation in adults: Need to be revisited?

Abstract

Editor—We read with much interest the special article by Frerk and colleagues1Frerk CM Mitchell VS McNarry AF et al.Difficult airway society 2015 guidelines for the management of unanticipated difficult intubation in adults.Br J Anaesth. 2015; 115: 827-848Abstract Full Text Full Text PDF PubMed Scopus (1139) Google Scholar about recent updated guidelines on the management of unanticipated difficult intubation in adults. The article appears to be very informative and assists in decision making. The authors described use of the scalpel-finger-bougie technique in case of impalpable cricothyroid membrane and suggested a midline vertical skin incision of 8–10 cm directed caudad to cephalad. We found an 8–10 cm length of incision over the trachea to be quite debatable, as it can lead to higher risk of bleeding/oozing from the local tissues making poor visualization of landmarks and risk of infection postoperatively. However, it can help in better palpation of the cricothyroid membrane.2Bagheri SC Bryan Bell B Khan HA Current Therapy in Oral and Maxillofacial Surgery. 1st ed. Elsevier Health US, 2011: 276Google Scholar We suggest the authors should acknowledge the use of techniques such as infiltration of local anaesthetic along with epinephrine, or the standby measures such as application of cautery (monopolar/bipolar), to stop bleeding at the local site while performing the procedure in an emergency. None declared. Difficult airway society 2015 guidelines for management of unanticipated difficult intubation in adults: Need to be revisited?: ReplyBritish Journal of AnaesthesiaVol. 117Issue 4PreviewEditor—Dr Tomar raises interesting points about the didactic approach to emergency front of neck access in the new DAS guidelines. Full-Text PDF Open Archive