Advanced airway management

Advanced airway management
An anesthesiologist using a video laryngoscope to intubate a patient with challenging airway anatomy
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Advanced airway management is the subset of airway management that involves advanced training, skill, and invasiveness. It encompasses various techniques performed to create an open or patent airway – a clear path between a patient's lungs and the outside world.

This is accomplished by clearing or preventing obstructions of airways. There are multiple causes of potential airway obstructions, including the patient's own tongue or other anatomical components of the airway, foreign bodies, excessive amounts of blood and body fluids, or aspiration of food particles.

Unlike basic airway management, such as the head tilt/chin lift or jaw-thrust maneuver, advanced airway management relies on the use of medical equipment and advanced training in anesthesiology, emergency medicine, or critical care medicine. Certain invasive airway management techniques can be performed with visualization of the glottis or "blind" – without direct visualization of the glottis. Visualization of the glottis can be accomplished either directly by using a laryngoscope blade or by utilizing newer video technology options.

Supraglottic airways in increasing order of invasiveness are nasopharyngeal (NPA), oropharyngeal (OPA), and laryngeal mask airways (LMA). Laryngeal mask airways can even be used to deliver general anesthesia or intubate a patient through the device. These are followed by infraglottic techniques, such as tracheal intubation and finally surgical techniques.

Advanced airway management is a key component in cardiopulmonary resuscitation, anesthesia, emergency medicine, and intensive care medicine. The "A" in the ABC mnemonic for dealing with critically ill patients stands for airway management. Many airways are straightforward to manage. However, some can be challenging. Such difficulties can be predicted to some extent by a physical exam. Common methods of assessing difficult airways include a Mallampati score, Cormack-Lehane classification, thyromental distance, degree of mouth opening, neck range of motion, body habitus, and malocclusion (underbite or overbite). A recent Cochrane systematic review examines the sensitivity and specificity of the various bedside tests commonly used to predict difficulty in airway management.^[1]