Unanticipated difficult intubation.
OBJECTIVE
While there are many predictors of difficult laryngoscopic intubation, they all have a low positive predictive value. Therefore, unanticipated difficult laryngoscopic intubation will likely occur in our day-to-day practice. This review discusses recent developments in alternative airway devices and techniques in addressing these difficulties.


RESULTS
There is emerging evidence to suggest that new supraglottic devices are useful rescue appliances, particularly for unanticipated difficulties in laryngoscopic intubation. Other new intubating devices, including the Glidescope, may also play an important role in the management of patients with unanticipated difficult or failed laryngoscopic intubation.


CONCLUSIONS
The evidence to date does not always arm us with the ability to predict a difficult laryngoscopic intubation. Therefore, it is imperative that we equip ourselves with devices and techniques that will help us to maintain effective oxygenation and ventilation in a safe manner in the face of such failure.
Hung
Orlando
O
Department of Anesthesia, Surgery, and Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada. hungorla@dal.ca
Murphy
Michael
M