Abstract
The American Society of Anesthesiologists revised the practice guidelines for management of the difficult airway in 2003, and the Difficult Airway Society released guidelines for management of unanticipated difficult intubation in 2004. Both guidelines mainly described how to manage cases of unanticipated difficult intubation after typical anesthesia induction.
In the face of difficult laryngoscope cases after anesthesia induction, several maneuvers should be tried to optimize the laryngoscopic view, such as head extension, changing the laryngoscope blade, and BURP. Moreover, these guidelines recommend use of guide introducer for tracheal intubation, especially the gum elastic bougie (GEB) . In cases when ventilation via mask is in adequate or intubation after several direct laryngoscopic attempts is unsuccessful, laryngeal mask is recommended using for securing airway.
The usefulness of both GEB and laryngeal mask were analyzed using a simple strategy as follows: the GEB and the intubating laryngeal mask were proposed as the first and second steps in the case of failed laryngoscope-assisted tracheal intubation, respectively. This strategy was able to secure an airway in 95% of unanticipated difficult airway cases.
I think that the DAM standard is the minimum requirement for airway management for anesthesiologists, that is, they have to be familiar with using GEB and laryngeal mask in case of failure of a direct laryngoscopic attempt.
