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).

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. 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). While inadequate oxygenation and ventilation has decreased in the operating room with the adoption of pulse oximetry as a standard for...

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