• Decision Making in Airway Management and Advanced Airway Evaluation

  This lecture describes the process of integrating available patient information along with the clinician's experience with airway management techniques in order to design a rational airway plan for all patients requiring airway management. Topics include 1) the need for airway control, 2) evaluation for difficult laryngoscopy, 3) evaluation for supralaryngeal airway ventilation, 4) aspiration risk, and 5) evaluation of judgment error risk. Advanced airway evaluation.

• Conscious sedation and failed conscious sedation, including monitoring (O2sat, ETCO2, Impedance monitors) and basic airway maneuvers (head tilt, chin lift, oral aw, nasal aw, mask vent, tracheal intubation)

  The decision making concepts of the first lecture are applied to the patient with undergoing conscious sedation.

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• The Pediatric Airway / Obstetric airway 

  The difference between adult and pediatric anatomy is reviewed. The rationale for eliminating certain "adult" techniques from the pediatric airway armamentarium, and unique pediatric techniques are discussed.

•  Aids to Direct Laryngoscopy (e.g., bougie, positioning and laryngeal manipulation)

  Techniques and devices which can be employed when direct laryngoscopy fails are reviewed

• Awake Intubation

  When it has been determined that the patient requires a technique of awake intubation, several distinct factors must be addressed, and a plan formulated. These factors include: 1) explanation to the patient, 2) drying of airway secretions, 3) nasal vasodilatation, 4) planned airway analgesia, 5) sedation, and 6) time management. The importance of weighing these 6 facets equally is emphasized. 

• Flexible intubation scope (e.g., FOB) intubation

  Successful use of the flexible intubation scope depends on an understanding of the construction of this highly engineered device, as well as the pitfalls of its use. This lecture explores the mechanics of the fiberscope and how it is best manipulated for maximum control. Patient pathology and the obstacles which are encountered are reviewed.

• Other Indirect Vision Devices (Video Stylet, Video Laryngoscopes, Channel Scopes, etc.)

  Rigid, malleable, and distal camera devices have recently been added to the armamentarium of the airway manager. The role of these devices is reviewed, including specific situations where each may have an appropriate application. Every new medical technology has the potential to introduce new complications. This is very true of the video laryngoscopes, and is highlighted. 

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• Supraglottic Airways

  The ASA task force on the difficult airway has recognized that SGAs must become a mainstay of airway management. In 2003, their status was elevated from the role of emergency airway rescue to routine devices. In 2013, it was recognized that SGAs other than the classic LMA also play a role. The rationale for the new prominence of SGAs, as well as the tremendous variety of these devices, will be discussed in the context of difficult airway management, as well as how they can improve routine practice.

• Minimally Invasive Airway Management

  When a patient's airway fails and cannot be managed by routine means, the ASA recommends that invasive measures are instituted. In fact, the ASA Closed Claims database recognizes that a major cause of patient morbidity is the delayed institution of these techniques. This does not mean that the anesthesiologist must be able to perform a surgical airway! Minimally invasive techniques of Transtracheal Jet Ventilation and Percutaneous Cricothyroidotomy are relatively simple techniques.

• The Vortex Approach

A new concept in managing the failed airway, the Vortex Approach was introduced as a cognitive aid when working with multiple team members in an airway code when it is near impossible to follow published algorithms. The Vortex Approach is also incorporated into the AOD simulation course. 

• Extubation of the Difficult Airway

  The Closed Claims database has recognized that, subsequent to the publication of the ASA algorithm, morbidity occurring during intubation has fallen. Unfortunately, there has been little change in morbidity occurring during tracheal extubation. Recent data has shown that reintubation failure can occur in 72% of patients. Most airway courses fail to address this issue. This course will discuss a rational plan for pre-extubation assessment of airway patency and techniques aimed at facilitating reintubation