“I Can’t Ventilate!” Intraoperative Anesthesia Safety Events and Airway Management

Management of the difficult airway is guided by expert algorithms and consensus. Maintenance of adequate patient oxygenation is the first priority. The best indicator that a patient may be easily ventilated or intubated is a history of prior success. In the absence of prior records, the best available method to predict difficult mask ventilation is airway examination and a review of comorbid conditions. Whenever both mask and supraglottic airway device ventilation are impossible, intubation should be attempted by a skilled physician using a familiar technique to have the greatest likelihood of success. Repeated attempts at intubation or ventilation using supraglottic airway devices should be limited as they may result in edema, bleeding, and deterioration of the airway condition. The decision to try awakening the patient or using emergency invasive airway access should be considered promptly if the airway is not secured.