VIEW SELECTED LIBRARY MEDIA

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Name of Media:

DAS guidelines for management of unanticipated difficult intubation in adults 2015

Author(s):

Difficult Airway Society (DAS)

Publisher or Source:

Difficult Airway Society (DAS)

Type of Media:

Medical Professional Education

Media Originally for:

Critical Care Physicians,Nurses and/or Other Critical Care Medical Professionals

Country of Origin:

United Kingdom of Great Britain and Northern Ireland (the)

Primary Focus of Media:

Pre-Use of PICS Designation

COVID-19 Related:

No

Description:

These guidelines provide a strategy to manage unanticipated difficulty with tracheal intubation. They are founded on published evidence. Where evidence is lacking, they have been directed by feedback from members of the Difficult Airway Society and based on expert opinion. They have been informed by advances in the understanding of crisis management and emphasise the recognition and declaration of difficulty during airway management. A simplified, single algorithm now covers unanticipated difficulties in both routine intubation and rapid sequence induction. Planning for failed intubation should form part of the pre-induction briefing, particularly for urgent surgery. Emphasis is placed on assessment, preparation, positioning, preoxygenation, maintenance of oxygenation, and minimising trauma from airway interventions.

It is recommended that the number of airway interventions are limited, and blind techniques using a bougie or through supraglottic airway devices have been superseded by video- or fibre-optically guided intubation. If tracheal intubation fails, supraglottic airway devices are recommended to provide a route for oxygenation while reviewing how to proceed. Second-generation devices have advantages and are recommended. When both tracheal intubation and supraglottic airway device insertion have failed, waking the patient is the default option. If at this stage, face-mask oxygenation is impossible in the presence of muscle relaxation, cricothyroidotomy should follow immediately. Scalpel cricothyroidotomy is recommended as the preferred rescue technique and should be practised by all anaesthetists. 

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