Management of unexpected difficult airway at a teaching institution over a 7-year period

Study Objective: To review an anesthesiology department's experience with managing unexpected difficult airways over a 7-year time span. Design: Retrospective review of unexpected difficult airway reporting forms. Setting: A tertiary care teaching hospital. Patients: 447 patients who had an unanticipated difficult airway and had a difficult airway form filled out by their anesthesiologist. Measurements: Retrospective identification of pertinent physical features associated with difficult intubation was noted. The techniques chosen, their success, and the frequency with which the different advanced airway techniques were chosen was reviewed. Main Results: An anterior larynx was the most common anatomical feature associated with difficult laryngoscopy. When a laryngeal mask airway was placed in our patients, ventilation was possible in all patients. Intubation was successfully "blindly" achieved (ie, without the use of a fiberoptic bronchoscope) through the laryngeal mask airway in 52% of these patients. Fiberoptic intubation was unsuccessful in intubating approximately 10% of patients. The Bullard laryngoscope was the most common advanced airway technique chosen at our institution. Conclusion: Mastery with a number of advanced airway techniques should be sought, as multiple modalities may be needed when faced with managing an unexpectedly difficult airway. Formal written communication to the patient of an unexpected difficult airway encounter may allow future anesthesiologists to formulate an appropriate plan for patient care. (C) 2006 Elsevier Inc. All rights reserved.