preliminary emergency airway management is a crucial component for achieving a successful outcome. details of emergency airway management include: volume of the airway management drug solution administered; administration of preoxygenation/oxygenation; types of administration (intravenous vs direct vs sublingual vs oral); airway device used; devices used to assist in securing the airway (e.g., gum elastic bougies, laryngoscopes with bougie, tracheal tubes, supraglottic devices); effectiveness of airway devices (e., bougies, tracheal tubes, supraglottic devices).⁴⁸⁰

for adult and pediatric patients, the following monitoring parameters are included: heart rate; blood pressure; oxygen saturation; end-tidal carbon dioxide (if measureable); sweat rate; end-tidal sevoflurane or desflurane concentration. the following procedures are included to provide hemodynamic stability and maintain oxygenation: ventilator settings (mode and settings); sedation and analgesia (dose and method of administration); neuromuscular blockade (dose and method of administration); paralysis/asystole (dose, mode, duration).

as mentioned above, this portion of the guidelines includes the preferred airway devices for the specified situations and does not suggest any one device over another. the airway devices should be chosen based on the clinical scenario. in select situations, which include difficult situations and those requiring evaluation for potential interventions, a formal airway assessment is recommended. this may include formal assessment of airway anatomy/physiology, ability to visualize the airway (e.g., anatomic challenges of the neck and chest, levels of the cords), and ability to visualize/manipulate the airway (e., sternal depression). this portion of the guidelines describes the general principles for airway assessment that should be followed prior to performing any airway management technique, including, but not limited to, direct laryngoscopy. the specific details of airway assessment are covered in the management of difficult situations section below.

the comment sections have been included in an effort to provide the reader with additional information, or clarification on issues raised during the development of the guidelines. all comments received will be considered and addressed, including reviews, comments, and advice. correspondence is welcomed to the chair of the panel, dr. vb bhandari, and may be sent to the following address: chair, emergency airway management – acute care (eam-ac) section, american society of anesthesiologists (asa), 1601 n. wabash ave., suite 300, chicago, il 60611. suggestions for future updates to these guidelines are also encouraged. information on future updates can be found on the asa website, www.asanet.org/asa, or by contacting the asa office of regulatory affairs at ora@asanet.org.
the methodologic quality of the literature was evaluated using the quadas-2 criteria ([1]), with the following modifications: (1) literature on video laryngoscopy was excluded as this topic has been reviewed in the previous guidelines; (2) a quality item on the patient selection process and definition of control groups was not included for all study designs; and (3) for literature on teaching and learning, we excluded criterion related to the interpretation of study findings.
rigid intubation blades (32) of alternative designs and sizes are used in attempts to prevent oesophageal intubation during intubation attempts for emergency intubation. however, there are insufficient data to make recommendations. observational studies have reported high first attempt intubation success rates (96-100%) for patients with unanticipated or emergency difficult airways (category b3-b evidence). 478 case reports have reported successful intubation with various approaches, including use of bougies, introducers, and stylets, for patients with unanticipated or emergency difficult airways (category b4-b evidence). 114, 478485
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