GASNet.org: Management of the difficult airway

Abstract

GASNet.org first went online in 1993; it was among the first 500 websites on the internet and was the first that was dedicated to anesthesia and critical care. GASNET.org is housed at Yale University, but it is a collaborative effort by several American anesthesiologists. Although it is primarily of interest to anesthesiologists, GASNet.org is a huge web site with much to offer from an educational perspective. Among many other resources, it features tutorials on acid–base, transesophageal echocardiography, hemodynamics, a clip art library, a multiplatform library of downloadable freeware and shareware calculators, as well as a database of key articles relevant to anesthesia. The subject of this web report is a multimedia airway tutorial, which provides an excellent and up-to-date review of both basic and advanced airway techniques. The best way to access the tutorial is to go directly to the URL http://www.gasnet.org/airway/airway.htm. The tutorial is divided into 15 sections. It begins with a summary of pathological conditions that may complicate airway management – a feature seldom included in most airway tutorials. Other sections review airway anatomy and examination, the American Society of Anesthesiologists Difficult Airway Algorithm, and setting up a difficult airway cart for the operating room or the intensive care unit. A section on airway adjuncts such as lighted stylets, gum bougies and laryngeal masks instructs on the advantages and disadvantages of each alternative, should conventional direct laryngoscopy be unsuccessful. The tutorial finishes with a step-by-step illustration of rarer techniques such as retrograde intubation, cricothyrotomy and use of airway exchangers. Each of these sections finishes with a video demonstrating the technique. The tutorial's layout is clean and well referenced (with direct links to abstracts on PubMed.com) and it has an excellent navigation system. Many pages feature only a single paragraph, which is an approach that is designed to hold users' attention, rather than requiring them to scroll through line after line of text. The airway tutorial takes advantage of the latest web browser technology to provide a sophisticated navigation panel and streaming video. The authors recommend viewing the site with Internet Explorer 5.0 or Netscape 4.0, or later versions, and the Apple QuickTime 4.0 plug-in is required to view the videos.