J Korean Med Assoc JKMA Journal of the Korean Medical Association 1975-8456 Korean Medical Association 10.5124/jkma.2007.50.12.1048 Focused Issue of This Month Recent Concepts of Anesthesia Airway Management Kim Si-Oh MD Department of Anesthesiology and Pain Medicine, Kyungpook National University College of Medicine, Korea. sokim@knu.ac.kr 12 2007 31 12 2007 50 12 1048 1056 Copyright © 2007 Korean Medical Association 2007

Airway management is still perceived as the greatest patient safety issue and the key task that anesthesiologists perform. Management includes mask ventilation, use of a laryngoscope, and the endotracheal intubation and extubation of the patient. Difficulty can be encountered at any of these stages, and can be a major cause of anesthesia-related morbidity and mortality. Competence in airway management requires knowledge of the anatomy and physiology of the airway, ability to access the patient's airway for the anatomic features that correlate with difficulties in airway management, skill with the many devices used in airway management, including a variety of recently-introduced airway tools, and the appropriate application of the sophisticated algorithm for difficult airway management. Development and clinical distribution of supraglottic airway devices and their enhancement, as well as the broad acceptance of awake fiber-optic intubation, has led to profound changes in the strategy for managing a difficult airway. Including the American Society of Anesthesiologists, many countries have developed their own airway management algorithm these days. Nevertheless, massive national and international deficits still exist in implementing these guidelines into practice as well as the implicated structural requirements with respect to education, reflection, team building and equipment concerning each individual institution. In regard to this situation, it is the recommendation of the author that our country develop and institute such a standardized system of airway management.

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Mallampati classification.

Laryngeal Mask Airways.

A) Classic LMATM with different sizes.

B) LMA FastrackTM.

C) LMA ProSealTM (from www.lmana.com).

Insertion of the laryngeal mask airway (LMA). A) The tip of the cuff is pressed upward against the hard palate by the index finger while the middle finger opens the mouth. B) The LMA is pressed backward in a smooth movement. Notice that the nondominant hand is used to extend the head. C) The LMA is advanced until definite resistance is felt. D) Before the index finger is removed, the nondominant hand presses down on the LMA to prevent dislodgment during removal of the index finger. The cuff is subsequently inflated, and outward movement of the tube is often observed during this inflation. (from www.lmana.com)

Four grades of laryngoscopic view. Grade I is visualization of the entire laryngeal aperture, grade II is visualization of just the posterior portion of the laryngeal aperture, grade III is visualization of only the epiglottis, and grade IV is visualization of just the soft palate.

Combitube (A) and Light wand (B).

Disease states associated with difficult airway management

Components of the preoperative airway physical examination