UC Davis

New airway equipment has recently become available that has reduced morbidity and mortality. However, airway disasters still occur. This article discusses the prudent escalation of the use of advanced airway equipment to prevent these disasters. We illustrate when and how to use a gum elastic bougie and a video-laryngoscope (VL). We also strongly recommend the combined use of the VL together with a flexible intubation scope (FIS) for both asleep and awake intubation when dealing with a genuinely difficult airway. Blind intubations should no longer be performed today. When an airway has been recognized as difficult it is the safest to aim for an awake or at least a spontaneously breathing intubation if circumstances do not allow for an awake intubation. Emergency cricothyroidotomy needs to be prepared for so that it can be executed rapidly in case the attempted awake intubation leads to complete airway obstruction.