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Book and Media Reviews
August 20, 2008

Management of the Difficult and Failed Airway

JAMA. 2008;300(7):850-851. doi:10.1001/jama.300.7.jbk0820-b

Imagine going to work every day knowing that you may have to confront a difficult airway. The airway is really just a conduit for gas exchange: oxygen in, carbon dioxide out. When airway management goes well, that too seems incredibly simple. But when it goes badly, things can become complex and daunting.

As the authors of Management of the Difficult and Failed Airway remind their readers, despite decades of study, and even with the application of multiple criteria, there is no 100% sensitive and specific way of determining ahead of time which patients will develop a failed airway—defined as 3 unsuccessful attempts at tracheal intubation, the inability to keep oxygen saturation above 90%, or both. Unlike many other puzzles and challenges in an environment of increasingly digital practice, an airway emergency does not allow the luxury of as-needed consultation of a reference book, even if such a book were on one's hip in electronic form. The proper care of the patient with failed airway requires having detailed medical knowledge as well as the judgment and poise to go to a plan B or even a plan C if necessary.