Difficult airway management in an ambulatory surgical center?

PURPOSE OF REVIEW: This review will focus on two key aspects of difficult airway management in an ambulatory surgical center (ASC). First, the selection process of patients with known difficult airways suitable for this environment, and second, the requirements of a difficult airway cart to manage unexpected airway problems. RECENT FINDINGS: The decision whether to manage a patient with a previously documented difficult airways in an ASC requires a multidisciplinary approach. Many factors will influence this decision including the cause and severity of the airway problem, the type of procedure, the experience of the perioperative staff, and the availability of difficult airway management devices.Unexpected difficult airways will always occur in anesthesia. Difficult airway carts are, therefore, a requirement for any area in which anesthesia is to be conducted. The contents of these carts should reflect the need to maintain patient oxygenation to avoid morbidity and mortality. Regular training sessions should include both technical training in the use of equipment and nontechnical training to improve interpersonal communication during crises. SUMMARY: The management of ambulatory surgical practices must provide suitable difficult airway management equipment as well as technical and nontechnical training. Patients may present to an ASC with expected and unexpected difficult airways. Appropriate management of these patients requires advance planning to avoid poor outcomes.

The Williams Airway Intubator, the Ovassapian Airway and the Berman Airway as upper airway conduits for fibreoptic bronchoscopy in patients with difficult airways.

PURPOSE OF REVIEW: In this article we will summarize the available information on airways that have been suggested to provide a conduit for the bronchoscope in its passage through the upper airway during fibreoptic intubation. RECENT FINDINGS: The Williams Airway Intubator and the Berman Oropharyngeal Airway appear to be more likely to provide a conduit for the bronchoscope than the Ovassapian Fibreoptic Intubating Airway. SUMMARY: Though the Williams Airway Intubator and the Berman Oropharyngeal Airway are superior in this role, all the airways discussed here have major deficiencies in their function. Further research is needed in this field to meet the requirements of endoscopists in situations when it is crucial that equipment reliably fulfils its function.