Management of the Difficult and Failed Airway.  Edited by Orlando R. Hung, M.D., and Michael F. Murphy, M.D., F.R.C.P.C. New York, McGraw-Hill, 2008. Pages: 510. Price: $129.00.

Few scenarios in the practice of medicine stoke the fires of immediate concern quite like encountering a difficult and failed airway. Unfortunately, adequate prediction of potentially challenging anatomy remains far from a perfect science despite having been the cornerstone of modern anesthetic practice for decades. The ever present possibility for disaster fuels continuing discourse not only throughout anesthesia but also across many other disciplines over methods and techniques with which to approach such problematic cases. The magnitude of this problem is reflected in the seemingly endless supply of novel and innovative airway devices and the sheer quantity of ongoing research ventures aimed at improved understanding of the complex interplay between anatomy, pharmacology, and airway manipulation. Indeed, the absolute increases in the volume of both our knowledge and technology are exceeded only by the rate at which they are escalating.

Whether the discipline is anesthesiology, emergency medicine, intensive care, or first response, securing the difficult and challenging airway in virtually any situation is the focus of this extremely useful book. Edited by two of Canada’s well-regarded airway management experts, the text offers a number of additions to existing difficult airway manuals in both its content and its formulation of the difficult airway approach.

Starting with a well-written and informative introduction to emergency airway algorithms and their similarities to and discrepancies from the American Society of Anesthesiologists Difficult Airway Algorithm, the book delves into a thoroughly informative discussion on how the editors’ Canadian twist on established practice results in improvements to airway management that can be applied to virtually any emergent situation. The text continues with a comprehensive background discussion of devices in and techniques for the difficult airway that serve as the basis of the aforementioned algorithmic progressions. These initial chapters build the foundation for the true value of this text.

The book includes topics that vary from airway management in the intensive care unit setting to the management of a motorcyclist with a full face helmet. Each chapter tackles a new airway management dilemma with an informal question and discussion style that permits both straightforward reading and rapid browsing and referral. Through analysis of the pitfalls and caveats associated with unique situations encountered at every step in the process of securing the airway, the authors manage not only to elucidate the fundamental principles inherent to emergent airway control but also to foster an objective approach to the control of the airway in any potential scenario. Each chapter even concludes with a small set of self-evaluation questions that are certainly beneficial to readers, especially those still in training.

It is difficult to edit the perfect text, and this book is no exception. It is not as comprehensive as some of the other available references on the market, and a subset of readers may not embrace the novel approaches inherent to the presented algorithms. In addition, it is surprising to note that the discussion on “the best way to confirm placement of an endotracheal tube in the trachea,” included in the chapter entitled “Airway Devices and Techniques,” is too casual and possesses a reference list that ignores a number of rather important citations. The same complaints could be carried over to the discussions on “how do prehospital providers confirm and maintain intratracheal placement of the ETT” in chapter 13 and the chapter on “Aspiration: Risks and Prevention.” Both sections certainly lack depth and, yet again, an appropriate selection of references.

These criticisms, however, should not overshadow the text’s value to both junior trainees and veteran anesthesiologists alike. Well written, functionally organized, and implementing algorithms that may be complementary to the established knowledge base of the majority of readers, Management of the Difficult and Failed Airway  receives our highest recommendation for any practitioner interested in improving his or her knowledge of airway management.

*Advocate Illinois Masonic Medical Center, Chicago, Illinois.