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A30 Anesthesia
Appendices Toronto Notes 2019 Appendices
Difficult Tracheal Intubation in Unconscious Patient
Optimized primary approach to intubation unsuccessful Does facemask or SGD ventilation maintain adequate SpO2?
YES
Can oxygenate
you have TIME for other option
Up to 2 further intubation attempts
• Alternative device
• Different operator
OR...proceed directly to exit strategy
Failed intubation
Options — consider
• Awakening patient
(not always feasible or appropriate)
• Proceeding with case (or temporizing) using face mask or SGD ventilation
• Obtaining expert help or equipment for additional controlled intubation
attempt
• Cricothyrotomy or tracheotomy
(in rare circumstances only)
Figure 17. Difficult tracheal intubation encountered in the unconscious patient
SGD = supraglottic device
NO
Cannot oxygenate
you have NO TIME for other option
Failed oxygenation
Succeeds
One attempt at SGD if not already tried
Reprinted with permission. Law JA, et al. The difficult airway with recommendations for management – Part 1 – Difficult tracheal intubation encountered in an unconscious/ induced patient. Can J Anesth 2013;60:1089–1118.
Failed
Cricothyrotomy
EXIT STRATEGY
PLAN B PLAN A ALTERNATIVE APPROACH PRIMARY APPROACH
EMERGENCY STRATEGY