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Airway Management
Airway Management encompasses the specialist anaesthetic techniques - from face mask ventilation to advanced fibreoptic intubation - used to secure and maintain a safe, patent airway throughout anaesthesia and critical illness, protecting against aspiration and ensuring adequate oxygenation at every moment.
Overview
Airway management is one of the most critical competencies in anaesthesia, requiring expert assessment, planning, and execution of the most appropriate technique for each patient's airway anatomy and clinical situation. The anaesthesiologist assesses multiple anatomical and physiological factors - mouth opening, neck mobility, Mallampati score, thyromental distance, BMI, and prior airway history - to predict and plan for airway difficulty before anaesthesia is induced. A clear plan A, B, and C is formulated for every anaesthetic, and all necessary equipment for difficult airway management is confirmed available before induction of anaesthesia.
Types of Airway Management Techniques
The airway device and technique selected depend on the patient's anatomy, the surgery type, and the urgency of the situation.
- Face Mask Ventilation (basic - for short procedures and preoxygenation)
- Laryngeal Mask Airway (LMA - supraglottic device for spontaneous ventilation)
- Proseal and i-gel LMA (sealed supraglottic devices allowing positive pressure ventilation)
- Direct Laryngoscopy and Intubation (Macintosh blade - standard endotracheal intubation)
- Video Laryngoscopy (McGrath, C-MAC - improved glottic view for difficult airways)
- Awake Fibreoptic Intubation (for anticipated difficult or impossible intubation under topical anaesthesia)
- Surgical Airway (cricothyrotomy or emergency tracheostomy for cannot-intubate cannot-oxygenate)
Risk Factors for Difficult Airway
Identifying difficult airway risk factors before anaesthesia allows advance preparation of specialised equipment and techniques.
- Mallampati Class III or IV - limited oropharyngeal view
- Reduced mouth opening (below 3 cm) from TMJ disease, previous radiotherapy, or trismus
- Short neck with reduced cervical extension
- Morbid obesity - increased soft tissue around the airway
- Obstructive sleep apnoea - redundant pharyngeal tissue
- Previous neck surgery, radiotherapy, or known airway pathology
- Large tongue, high arched palate, or prominent upper incisors
- History of previous difficult intubation documented in anaesthetic records
Indications for Advanced Airway Management
Advanced airway management is indicated whenever standard techniques are predicted or found to be insufficient.
- Predicted difficult intubation - awake fibreoptic intubation planned before induction
- Emergency airway in unconscious patients - rapid sequence induction
- Full stomach aspiration risk - rapid sequence induction with cricoid pressure
- Prolonged mechanical ventilation in ICU - tracheostomy for comfort and secretion management
- Airway obstruction from tumour, foreign body, or trauma
- Major head and neck surgery requiring secure protected airway throughout
- Patients who have failed intubation with standard laryngoscopy
- Neonatal and paediatric difficult airways requiring specialist paediatric anaesthesia expertise
Key Benefits
Discover the advantages of choosing our airway management services.
Pre-planned airway strategy eliminates hesitation during difficult airway management
Video laryngoscopy dramatically improves intubation success in difficult airways
Awake fibreoptic intubation provides the safest approach for known challenging airways
Rapid sequence induction protects against aspiration in full-stomach patients
Difficult airway alert documentation protects the patient at all future anaesthetics
Clinical Features
The technology, techniques and clinical approach behind our airway management.
Systematic airway assessment identifies difficult airway predictors before induction
Difficult airway trolley confirmed available before every single anaesthetic
Pre-oxygenation maximises the safe apnoea window during airway management
Capnography is the gold standard confirmation of correct endotracheal tube placement
Extubation performed with the same preparation and equipment readiness as intubation
Preparation Instructions
After intubation, you may experience a sore throat, hoarseness, and mild difficulty swallowing for 24 to 48 hours - these are common and resolve spontaneously. Inform the recovery nurse of any dental damage noticed on waking - this requires immediate documentation and dental review. If you experience significant airway difficulty at any future anaesthetic, request that a difficult airway alert be documented in your medical records for all future anaesthetics.
The Procedure
Step-by-step guide to what you can expect during your airway management procedure.
Pre-Operative Airway Assessment
A systematic examination of mouth opening neck mobility thyromental distance Mallampati score and dental condition identifies all predictors of difficult intubation -- the plan A B and C formulated before anaesthesia is induced.
Equipment Preparation and Team Briefing
All airway equipment is confirmed available -- standard and video laryngoscopes multiple ETT sizes LMA options fibreoptic scope and cricothyrotomy kit. The theatre team is briefed on the airway plan and backup strategies.
Pre-Oxygenation and Optimal Positioning
100% oxygen via tight-fitting mask for 3 to 5 minutes maximises the blood and lung oxygen reservoir. Optimal positioning -- ramped for obese patients -- aligns the oral pharyngeal and laryngeal axes for the best laryngoscopic view.
Anaesthesia Induction and Airway Securing
Anaesthesia is induced and the planned airway device placed. Correct ETT position is confirmed by capnography waveform chest auscultation and chest X-ray if required -- capnography is the gold standard for tube position confirmation.
Difficult Airway Management
If plan A fails the team moves immediately to plan B and C as pre-planned. Video laryngoscopy significantly improves the view in difficult airways. Awake fibreoptic intubation provides the safest approach for predicted impossible intubation.
Extubation Planning and Recovery
Reversal of muscle relaxation is confirmed spontaneous breathing is adequate and protective reflexes have returned before extubation -- performed with the same level of planning and equipment readiness as intubation.
What to Expect
Your anaesthesiologist performs a careful airway assessment during the pre-operative visit - examining your mouth opening, neck movement, jaw structure, and teeth. In theatre, pre-oxygenation with 100% oxygen before induction maximises your safety margin. Airway management proceeds according to the pre-planned strategy and the anaesthesiologist continuously confirms ventilation and oxygenation at every step until the correct airway device position is verified.
Frequently Asked Questions
Common questions about airway management.
Related Services
Explore other services in our Anaesthesiology department.
General Anaesthesia
Spinal Anaesthesia
Epidural Anaesthesia
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