Since the last edition of our textbook, strategies and guidelines in managing the difficult and failed airway from the American Society of Anesthesiologists, the Canadian Airway Focus Group, the Difficult Airway Society in the United Kingdom, and other organizations have been updated and revised using the currently available evidence. These revised recommendations for the management of the difficult and failed airway are reflected in all chapters of this edition of the textbook including the new chapters. For example, two chapters (Chapters 6 and 34) were added to this edition to address “human factors” as they relate to the stresses and strains of difficult and failed airway management. The Difficult Airway Society guidelines specifically acknowledge the importance of human factors in crisis resource management. Interpreted in context, the application of the four basic methods of oxygenation (bag-mask-ventilation, use of extraglottic devices, tracheal intubation, and front of neck access) remains the most logical approach for managing a failed airway. Furthermore, the National Audit Project 4 (NAP4) and other studies have consistently identified difficulties associated with needle (Seldinger technique) cricothyrotomy such that it has become clear that when faced with a “cannot intubate, cannot oxygenate” (CICO) situation, surgical (open) cricothyrotomies are much more successful than needle or Seldinger cricothyrotomies. Many chapters of this edition emphasized the importance of early front of neck access using open cricothyrotomy in the adult population.
This edition is divided into ten sections: the first section consists of the foundational information in airway management; the second section reviews airway devices and techniques; the third to the ninth sections discuss airway management in different clinical settings, including prehospital care, in the Emergency Department, the Intensive Care Unit, the operating room, the Post Anesthetic Care Unit, as well as other parts of the hospital; and the last section highlights practical issues in airway management. A number of new chapters and clinical cases have been added to this new edition. As indicated above, two chapters have been added to discuss human factors in airway management. To avoid confusion related to “front of neck” access, a tracheotomy chapter has been added to this edition. In addition, chapters discussing the management of patients with the aspiration of gastric contents, obstructive sleep apnea, tracheal stenosis requiring jet-ventilation, and airway management under combat conditions have been added to this edition.
Videos depicting all airway management techniques are available at http://DifficultAirwayVideos.com. Bag mask ventilation, topical anesthesia of the upper airway, and open cricothyrotomy videos have been added to this edition.