1. Airway management
Second cause of mortality in anaesthesia in 1996 in France = 1/3 of the anaesthesia mortality.
600 deaths in UK in 1990
15 to 30% of the predictable difficult intubation was not identified.

2. A Clinical Case: The Reality in 2014
62 years old, male, with history of diabetes and hypertension controlled by medications
175 cm – 86 kg.
ASA II
Previous surgeries uneventful
History of previous surgery / GA with intubation (no documentation of any airway difficulties)
No predictive factor of difficult intubation or mask ventilation
Mallampati II
Posted for elective Cholecystectomy/ laparoscopy

3. Anaesthesia induction
Post induction
Pre oxygenation : MASK ON THE FACE
Monitoring ; SPO2 NIBP SCOPE Exp CO2
DRUG INDUCTION
Fentanyl = 50 mcg
Lido IV = 60 mg
Propofol = 100 mg
Atracurium = 50 mg
IMPOSSIBLE TO BAG THE PATIENT
1ST LARYNGOSCOPY = NO VISION
Call for help
Tried to bag the patient

4. Anaesthesia induction
Pre oxygenation : MASK ON THE FACE
Monitoring ; SPO2 NIBP SCOPE
DRUG INDUCTION
Fentanyl = 50 mcg
Lido IV = 60 mg
Propofol = 100 mg
Atracurium = 50 mg
IMPOSSIBLE TO VENTILATE
IMPOSSIBLE TO INTUBATE

5. WHAT TO DO FIRST Patient still with a good SPO2
ASK FOR CRICOTHYROTOMY SET
LARYNGOSCOPY
LARYNGOSCOPY PLUS ELASTIC BOUGIE
TREAT THE BRONCHOSPASM
LMA
INTUBATING LMA
DO NOT DO ANY MANOEUVRES - MAKE ANESTHESIA DEEPER

6. THE REALITY LARYNGOSCOPY Blind intubation with Bougie
TRIED CRICOTHYROTOMY by no air in the lung
LMA = Cannot ventilate => REMOVED
DRUGS FOR BRONCHOSPASM (Aminophylline Hydrocortisone...)
INTUBATING LMA = IMPOSSIBLE
Patient “Extreme” Bradycardia = START CPR Atropine adrenaline
Ketamine 100 mg => Patient intubated back to SPO2 100%
Transfert to ICU => patient Died

7. Airway management is still a main concern in 2015
Guidelines are there to improve outcomes of intubation
Can we improve our airway assessment.
Can we train our airway skills.