The airway in anaesthetic practice

Abstract

This chapter provides a comprehensive review of current airway management set against its historical context and likely future developments in the field. Developments in equipment design are discussed against the background of a short review of the anatomy and physiology relevant to clinical airway management. An exploration of airway devices examines progress in design from the first facemasks and early hands-free delivery systems, through to current second-generation supraglottic airways and the future of providing improved protection against aspiration. Continuing advances in tracheal tube and cuff design are set alongside developments in techniques and equipment for laryngoscopy and possibilities for supplementing capnography in confirmation of correct tube placement within the trachea. The use of newer drugs to facilitate control of airway reflexes is also discussed. The importance of using optimal evidence-based techniques in airway management is highlighted in the reduction of complications. This covers preoperative evaluation of the airway, planning a strategy, induction of anaesthesia, and establishing a clear airway through to safe termination of anaesthesia, emergence, tracheal extubation, and recovery. Techniques for dealing with complications if they arise are described. Drawing on lessons from the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society ‘Major complications of airway management in the United Kingdom’ (NAP4) and the general literature, emphasis is placed on high-risk areas of airway management and areas where the existing knowledge base is not covered in depth in other texts.