Difficult airwaymanagement

BACKGROUND: In case of distorted airway anatomy, awake intubation with a flexible bronchoscope can be extremely difficult or even impossible. To facilitate this demanding procedure, an infrared flashing light source can be placed on the patient's neck superficial to the cricothyroid membrane. The light travels through the skin and tissue to the trachea, from where it can be registered by the advancing bronchoscope in the pharynx and seen as flashing white light on the monitor. We hypothesised that the application of this technique would allow more proximal and easier identification of the correct pathway to the trachea in patients with severe airway pathology...

Airway management in the prehospital setting is a particular challenge. Even with numerous alternative devices, endotracheal intubation still represents the gold standard. Limited knowledge and experience of the user in addition to a critical patient's condition, special environmental conditions and limited material resources at the out of hospital emergency, are major causes of an increased incidence of difficult airways in the preclinical setting. For the management of the difficult airway emergency physicians can use alternatives to tracheal intubation such as extraglottic airway devices, videolaryngoscopy and cricothyroidotomy...

Endotracheal intubation remains the "goldstandard" in airway management. If with use of conventional techniques intubation of the patient fails, or if an anticipated difficult airway is present, video-assisted techniques may help to increase intubation success. Video-assisted techniques give the possibility to indirectly visualise the laryngeal structures with fibreoptical or camerachip-technique, and to display the videopicture on an external or integrated monitor. For the anticipated difficult airway, awake flexible fibreoptical intubation still is the first choice...