Principles of Airway Management, Third Edition.

Abstract

The University of Chicago, Chicago, Illinois. aovassap@dacc.uchicago.eduPrinciples of Airway Management, Third Edition. By Brendan T. Finucane, M.D., and Albert H. Santora, M.D. New York, Springer-Verlag, 2003. Pages: 503. Price: $59.95.Effective airway management is essential for safe administration of anesthesia and successful resuscitation of cardiac arrest patients. A new interest in the safety of airway management has emerged in the past 15 yr, signified by the introduction of new airway devices, the emergence of guidelines for managing the difficult airway, the large number of publications on the subject, and the formation of the Society for Airway Management. These strides are unmatched in any other period of 15 yr since the birth of general anesthesia in 1846. The introduction of the LMA-Classic ™ in 1988, followed by the LMA-Fastrach ™ and the LMA-ProSeal ™ (The Laryngeal Mask Company (UK) Limited, Bucks, United Kingdom), has generated more than 2000 publications alone.The third edition of Principles of Airway Management is a timely publication reflecting the changes and improvements in airway management. In this new edition, Drs. Finucane and Santora present 13 chapters of clinically useful, technically oriented information. With the exception of Chapter 1, “Airway Anatomy,” all of the chapters are extensively revised and expanded. The high quality of the drawings and pictures from the second edition is preserved, and many new ones are added. The third edition is expanded, with 160 more pages than the second edition.Several chapters are worthy of special mention. A well-deserved new chapter is devoted to laryngeal mask airways. The new chapter discusses the various applications of laryngeal mask airways in airway management, their role in management of a difficult airway, and their application in specific procedures such as fiberoptic bronchoscopy during general anesthesia. I was also impressed with the chapter discussing airway evaluation. Considering space limitations, there is thorough consideration of tests thought to predict difficult direct laryngoscopy, including the significant limitations of all these techniques. The chapter addressing the difficult airway benefits from the consideration of both difficult mask ventilation and difficult intubation. Appreciation of both is critical because each presents a different scenario and requires a different route in the difficult airway algorithm of the American Society of Anesthesiologists’ Practice Guidelines for Management of the Difficult Airway. Failure of both facemask ventilation and tracheal intubation presents an extremely dangerous situation, calling for good judgment, correct selection, and skillful application of the method to avoid brain damage or death. This chapter is also enhanced by a supplemental nine-page appendix that summarizes syndromes associated with a difficult airway. Another highlight includes the chapter dealing with fiberoptic intubation, specific techniques for intubation, and preparation of a patient for awake intubation. Several tables and drawings add to the value and clarity of this chapter.One criticism I have of this text is the arrangement of some of the materials. The chapter entitled “Fiberoptic Airway Management Techniques” would be better positioned after the chapter describing “The Difficult Airway.” The discussion of the complications of tracheal intubation would more logically follow the chapter describing techniques of tracheal intubation. The LMA-Classic ™ and LMA-ProSeal ™ should be presented early in the chapters describing basic airway management and basic airway management equipment, reflecting their fundamental importance in current practice. The LMA-Fastrach ™ and flexible bronchoscope should also be briefly mentioned in the intubation chapter, because their use is now routine in intubation techniques and must be mastered in nonemergency situations. The longest chapter, “Surgical Approach to Airway Management,” includes transtracheal jet ventilation and retrograde intubation, which do not seem to belong in this chapter.One of the unique strengths of this text is the emphasis on teaching of airway skills, especially that of rigid and fiberoptic intubation. Airway-related deaths, hypoxic brain damage, unnecessary tracheostomies, other major complications, and thousands of case cancellations after failed intubation each year are unacceptably high. We need better and more serious training of individuals engaged in airway management, and this text represents an important contribution to this effort.In summary, the authors should be commended for their contribution to the understanding of the basics and the importance of airway management. This text is well written and richly illustrated, with numerous excellent references. Reading this book is strongly recommended for all those engaged in airway management, from medical students to experienced practitioners. It offers practical clinical information that is critical for safe airway management and should be a readily available reference in all acute care settings.The University of Chicago, Chicago, Illinois. aovassap@dacc.uchicago.edu