How to Avoid These 10 Difficult Airway Pitfalls

Making Difficult Airways Less Difficult Via Training and Education

Robust training and education are crucial components of difficult airway management. Here are two ENT surgeons’ approaches to ensuring deep knowledge and skill levels on their multidisciplinary airway management teams.

Taher Valika, MD, the medical director of the aerodigestive program at Ann & Robert H. Lurie Children’s Hospital of Chicago, and his colleagues have presented the Chicago Advanced Airway Course every year for the past six years. The course brings together a multidisciplinary group of anesthesiology, pediatric surgery, and otolaryngology trainees and faculty, including residents and fellows from programs across the Midwest. Through simulation models and board-style emergency scenarios, participants practice both the technical skills and team-based decision-making required in pediatric difficult airway management. Last year, the course expanded its outreach through the Triological Society and drew more than 75 participants.

“We deliberately model high-stress, worst-case airway scenarios because that is what trainees need to be prepared for,” Dr. Valika said. “They practice the technical skills in real time, assembling and deploying a rigid bronchoscope, using a laryngeal mask airway as a rescue device and for flexible intubation, and escalating through a difficult airway algorithm under pressure.”

Most trainees will not see a high volume of true pediatric difficult airway emergencies, he acknowledged. “But when these cases happen, they happen fast. Simulation allows them to experience the stress, practice decision making under pressure, and build the muscle memory they may need during a real 3 a.m. emergency.”

“ENT! 911!” Lecture Series

To ensure the next generation of ENT surgeons is well-trained to manage difficult airway cases, Jonathan M. Bock, MD, presents an annual “ENT! 911!” lecture to residents and medical students on airway management, with a heavy emphasis on emergency cases.

“The chaos of these situations can trip up even relatively experienced surgeons,” said Dr. Bock, a professor in the division of laryngology and professional voice department of otolaryngology and communication sciences, Froedtert & Medical College of Wisconsin, in Milwaukee. “Oftentimes, there can be multiple teams of people at the bedside trying to assist, and so it can all get a bit crazy in the heat of the moment and hard to coordinate care.”

To successfully navigate these fraught situations, mental preparation is key. To that end, Dr. Bock instructs his medical students and residents to think of the patient as having already passed. “It may seem callous, but that way, when you are called on a case, you don’t feel like the entire outcome depends on your intervention; that can be overwhelming. So, I tell them to remember that this patient’s life is not all on your shoulders; you’re just one component of the surgical team.”

Dr. Bock also suggests that his trainees “take their own pulse at the bedside before they even consider intervening,” he said. By doing so, “you can get to a place where you are calm enough to take the next right steps.”