Manual of Emergency Airway Management, 3rd Edition. By Ron M. Walls, M.D. and Michael F. Murphy, M.D. Philadelphia, Lippincott Williams & Wilkins, 2008. Pages: 432. Price: $59.95.

Dealing with the expectation of providing a secure airway in a routine setting such as the operating room can often be a challenge. However, maintaining the same level of skill and confidence in patients with presumed difficult airways or worse, the dreaded unexpected difficult airway, can be problematic. In settings outside the operating room, difficult airway management can be even more demanding.

The Manual of Emergency Airway Management,  now in its third edition, is an excellent resource to better understand a stepwise approach to successfully provide airway management in a wide variety of emergent situations. The stated objective of the authors is to provide healthcare professionals such as internists, emergency department providers, intensivists, anesthesiologists, and first responders with a concise, reproducible, stepwise approach to airway management that is based on literature review and complemented by clinical expertise.

The authors have updated this third edition with simplified yet comprehensive airway algorithms. The pharmacology of the many induction and paralyzing agents that can be used in the emergency airway setting have been amended. Detailed, practical information regarding the technological advances that are beginning to revolutionize airway management has been greatly expanded. Finally, the section on prehospital emergency airway management has been broadened, as this is an area where the difficult airway may be more common.

The manual is extremely easy to read. Important ideas and themes are often emboldened in blue type. Each chapter has easy-to-read graphs, figures, tables, and photography. The book is coherently divided into seven broad sections, including Approach to the Airway, Difficult and Failed Airways, Pharmacology of Airway Management, Pediatric Airway Management, EMS Airway Management, Special Clinical Circumstances, and lastly, Mechanical Ventilation and Monitoring. Each chapter follows a logical sequence, beginning with an introduction, clinical challenges, approach to the airway, techniques, and often a Tips/Pearls section. However, what sets this manual apart may be the Evidence section at the end of each chapter. The authors provide updated literature detailing the reasoning behind some of the more controversial recommendations. The authors do not shy away from some potentially debatable topics and long-held beliefs, such as the recommendation to not routinely use atropine before succinylcholine in the pediatric population.

There are several chapters of particular interest to the anesthesiologist. The chapter on video laryngoscopy provides detailed information on many of the current commercially available devices. The authors detail the use of each video laryngoscope with a summation of the positives and the negatives for each. Helpful information on current literature regarding video laryngoscopy is provided in the Evidence section. The section on pediatric airway management spans only three chapters, but provides a concise yet relatively all-inclusive review of techniques available to better ensure successful airway management in this population. This section also offers useful new and updated information regarding the pediatric difficult airway.

Overall, this manual hits its intended mark by providing an easy-to-read, succinct, yet comprehensive approach to the patient in need of emergency airway management for all healthcare providers, be it an anesthesiologist, internist, intensivist, hospitalist, emergency department physician, or emergency medical service first responder.

*The Johns Hopkins Hospital, Baltimore, Maryland.