Module 12
The American Society of Anesthesiologists'
Management
of the Difficult Airway Algorithm
and Explanation-Analysis of the Algorithm
Problems with the ASA Algorithm
and Likely Future Directions
DEFINITION OF OPTIMAL-BEST ATTEMPT AT
CONVENTIONAL MASK VENTILATION
If the patient
cannot be intubated, then gas exchange is dependent on mask
ventilation. If the patient cannot be ventilated by mask,
then a CICV situation exists, and immediate organ-lifesaving
maneuvers must be instituted (see
Section E following). Since
each of the acceptable responses to a CICV situation has its own
risks, the decision to abandon mask ventilation should be made
after the anesthesiologist has made an optimal-best attempt at
mask ventilation.
 The
first component of optimal-best attempt at conventional mask
ventilation is that it should be a two-person effort (Fig. 7)
because far better mask seal, jaw thrust, and therefore tidal
volume can be achieved with two people versus one person.
The left-hand panel of Fig. 6 shows a proper two-person mask
ventilation effort when the second person knows how to perform
jaw thrust, and the right-hand panel of Fig. 7 shows a proper
two-person mask ventilation effort when the second person is
only capable of squeezing the reservoir bag.
The second
component of optimal-best attempt at conventional mask
ventilation is to use large oropharyngeal and/or nasopharyngeal
airways. If mask ventilation is very poor or nonexistent
with a vigorous two-person effort in the presence of large
artificial airways, then it is time to move on to a potentially
organ-lifesaving Plan B (see Figs. 1 and 2
and Section E following).
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