Management of the difficult airway remains one of the most relevant and challenging tasks for anesthesiologists. A major factor for this concern is the serious consequence of inadequate oxygenation and ventilation. Airway complications remain high on the list of categories in the ASA Closed Claims Database as a cause of death or permanent neurologic injury (Figure 1).1
In a review of anesthesiology closed claims cases in 1990, the leading causes of respiratory-related complications were inadequate ventilation, esophageal intubation and difficult intubation.2 Although esophageal intubation has nearly disappeared with the adoption of end-tidal capnography, difficult intubation remains a concern and represented 27 percent of all adverse respiratory events in 1991-2007 (Figure 2).3 While inadequate oxygenation and ventilation has decreased in the operating room with the adoption of pulse oximetry as a standard for intraoperative monitoring,4 it has risen in non-operating room locations, secondary...