Preface

While earlier guidelines and strategies from the American Society of Anesthesiologists (ASA), the Canadian Airway Focus Group (CAFG), and the Difficult Airway Society (DAS) in the United Kingdom help in managing patients with a difficult or failed airway, there are no specific strategies recommended to manage patients when all four fundamental techniques of oxygenation (face-mask ventilation, use of extraglottic devices, tracheal intubation, and front-of-neck access) are likely to fail; this situation is commonly considered an “impossible” airway.

Recent revisions of the ASA (2022) and CAFG (2021) strategies and guidelines for managing challenging airways recognized the importance of extracorporeal membrane oxygenation (ECMO) in the management of patients with an “impossible” airway. These guidelines have been updated and are reflected in all chapters of this fourth edition. For example, in this edition several chapters (Chapters 15, 21, 31, and 45) discuss the utilization of ECMO in various clinical settings for managing patients with “impossible” airways due to critically obstructive tracheal lesions or upper airway anatomical abnormalities. In other words, while the application of the four basic methods of oxygenation remains the most practical approach in managing a difficult or failed airway, ECMO should be considered in the setting of an impossible airway. However, it takes time to establish ECMO support, which needs specialized equipment and specialized practitioners, and for these reasons, ECMO is impractical in managing an emergency impossible airway or as a rescue airway technique.

Our goal is to provide the practitioner with a single resource with text and videos that provides strategies in managing the full spectrum of airway-related issues. This edition is divided into 10 sections: the first section consists of the foundational information on airway management; the second section reviews airway devices and techniques; the third to the ninth sections discuss context-sensitive airway management in a variety of 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 edition. As indicated above, four chapters have been added to discuss the role of ECMO in predicted impossible airway management. In addition, chapters discussing the management of patients with COVID infection, patients with opioid overdose, and patients undergoing robotic surgery, and the role of robotics and artificial intelligence in airway management and point-of-care ultrasound (POCUS) of the upper airway in airway management have been included.

In addition to the previous 30 videos on airway techniques, which can be accessed through McGraw Hill AccessAnesthesiology website, three more new videos have been added: Combined Intubation Techniques, Tips and Tricks to Improve Hyperangulated Video-Laryngoscopic Intubation, and the Utility of Extracorporeal Membrane Oxygenation (ECMO) in Airway Management.