Module 12
The American Society of Anesthesiologists'
Management
of the Difficult Airway Algorithm
and Explanation-Analysis of the Algorithm
Introduction
The literature provides strong evidence
that specific strategies facilitate management of the difficult
airway. Specific strategies can be linked together to form more
comprehensive treatment plans or algorithms. The purpose of the
American Society of Anesthesiologists' (ASA) Algorithm on the
Management of the Difficult Airway is to facilitate the
management of the difficult airway and to reduce the likelihood
of adverse outcomes. The principal adverse outcomes associated
with the difficult airway include (but are not limited to):
death, brain injury, cardiopulmonary arrest, unnecessary
tracheostomy, airway trauma and damage to teeth.
The original ASA Algorithm on the
Management of the Difficult Airway was developed over a 2yr
period by the ASA Task Force on Guidelines for Management of the
Difficult Airway.2
The task force consisted of Robert A. Caplan, M.D. (Chair);
Jonathan L. Benumof, M.D.; Frederic A. Berry, M.D.; Casey D.
Blitt, M.D.; Robert H. Bode, M.D.; Frederick W. Cheney, M.D.;
Richard T. Connis, Ph.D.; Orin F. Guidry, M.D.; and Andranik
Ovassapian, M.D., and therein included academicians, private
practioners, airway experts, adult and pediatric anesthesia
generalists, and a statistical methodologist. The algorithm was
approved by the ASA House of Delegates, October 21, 1992, and
became effective July 1, 1993. David Nickinovich,
Ph.D. became an additional member of the Task Force in the
revision of the Practice Guidelines, which were submitted and
accepted for publication October 23, 2002.47
This revised algorithm takes into account another 10yrs of data
and recommendations for a wider range of management techniques
than was previously addressed.
This chapter presents and
explains the ASA Algorithm on the Management of the Difficult
Airway. The algorithm is concerned with the maintenance of
airway patency at all times. Special emphasis is placed on an
operating room setting (although the algorithm can be
extrapolated to the intensive care unit and the ward). The
algorithm is intended for use by anesthesiologists or by
individuals who deliver anesthetic care and airway management
under the direct supervision of an anesthesiologist. The
guidelines, themselves, apply to airway management during all
types of anesthetic care in different anesthetizing locations
and is intended for all patients of all ages. Adherence to the
principles of the Difficult Airway Management Algorithm and the
widespread adoption of a precise plan for management of airway
difficulties should result in reduction of respiratory
catastrophes and a decrease in anesthesia morbidity and
mortality.
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