Practice Guidelines for Management of the Difficult Airway

P RACTICE Guidelines are systematically developed recommendations that assist the practitioner and patient in making decisions about health care.These recommendations may be adopted, modified, or rejected according to clinical needs and constraints and are not intended to replace local institutional policies.In addition, Practice Guidelines developed by the American Society of Anesthesiologists (ASA) are not intended as standards or absolute requirements, and their use cannot guarantee any specific outcome.Practice Guidelines are subject to revision as warranted by the evolution of medical knowledge, technology, and practice.They provide basic recommendations that are supported by a synthesis and analysis of the current literature, expert and practitioner opinion, open-forum commentary, and clinical feasibility data.This document updates the "Practice Guidelines for Management of the Difficult Airway: An Updated Report by the Task Force on Difficult Airway Management," adopted by the ASA in 2002 and published in 2003.* Methodology A. Definition of Difficult AirwayA standard definition of the difficult airway cannot be identified in the available literature.For these Practice Guidelines, a difficult airway is defined as the clinical situation in which a conventionally trained anesthesiologist experiences difficulty with facemask ventilation of the upper airway, difficulty with tracheal intubation, or both.The difficult airway represents a complex interaction between patient factors, the clinical setting, and the skills of the practitioner.Analysis of this interaction requires precise collection and communication of data.The Task Force urges clinicians and investigators to use explicit descriptions of the difficult airway.Descriptions that can be categorized or expressed as numerical values are particularly desirable, because this type of information lends itself to aggregate analysis and cross-study comparisons.