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Practice Guidelines for Management of the Difficult Airway:
An Updated Report by the American Society of Anesthesiologists
Task Force on Management of the Difficult Airway
Anesthesiology 2003; 98(5):1269-1277

Address reprint requests to the American Society of Anesthesiologists: 520 North Northwest Highway, Park Ridge, Illinois 60068-2573.
Individual Practice Guidelines may be obtained at no cost through the Journal Web site, www.anesthesiology.org

Newly released is the ASA's "systematically developed set of recommendations based on analysis of the current literature and a synthesis of expert opinion."
It replaces the 1993 report. It includes data published since 1992 and recommends a wider range of management techniques.
This expert document will be, as were the previous versions, a cornerstone in examining an appropriate standard of care.

Difficult Airway "Sidebar"

(Commentary for Emergency Nurses Upon the New Guidelines from ASA)

By Tom Trimble, RN

  1. Why has ENW! posted this notice?

    It is an important revision of the leading document defining "Practice Guidelines for Management of the Difficult Airway". Critical airway management and confronting a "difficult airway" are essential components of Emergency Medicine and an inescapable responsibility.

  2. Why is this document significant?

    These guidelines for management of the difficult airway are the only authoritative declaration upon the subject. The evaluation and process suggested are the basis of approaching such problems. As such, it will be cited in any expert testimony or review.

  3. But, it’s from anesthesiologists, --not Emergency Medicine.

    Yes. Anesthesiologists have, over a decade, formalized their review of such problems and through these guidelines, improved monitoring, improved and new equipment have lowered the incidence and liability of airway problems. While Emergency Medicine has had articles, text material, and courses upon Difficult Airway Management, no organized body for the specialty has defined such a document.

  4. Why should I be aware of this document?

    It is important for the Emergency Nurse to be aware of what may be asserted as "Standard of Care", to follow evolution of approach and management, and to be fully prepared to assist at each step that may occur until the airway is secured and the management thereafter until the patient arrives at his next destination.

  5. What’s different about the guidelines now?

    An evidence-based review; updating due to literature, experience, new equipment since the last revision; a greater role of alternative airways (LMA®, Combitube®, jet stylets) before invasive/surgical airways

  6. How else will this affect me?

    It is likely that you will have additional airway equipment in the department with which to be competent. The more closely you understand the physician’s thinking and plan, the more ready and apt you will be when moments are critical.

  7. What elements might help anticipate a potential difficult airway?

  8. What likely alternative airway methods must I be ready for?

  9. What airway equipment is likely to be stocked?

  10. So, what’s the algorithm? (Understanding that it was devised for anesthesia in an operating room setting)

  11. What else should my department do?

    It should review any present plan; determine any adaptation needed; procure and train upon any new equipment, and implement any new procedures; ensure all staff are prepared and have competencies verified. While Emergency Medicine in your institution must define what it will do and plan appropriately, it should consult and coordinate collegially with available anesthesia back-up.


"Difficult Airway Sidebar - Commentary for Emergency Nurses Upon the New Guidelines from ASA"

is a webarticle presented by:
Emergency Nursing World !
©Tom Trimble, RN [[email protected]]

The illustrations are from

Anesthesiology 2003; 98(5):1269-1277
Copyright © 2003 American Society of Anesthesiologists. All rights reserved
Published by Lippincott Williams & Wilkins



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