title: All India Difficult Airway Association 2016 guidelines for the management of unanticipated difficult tracheal intubation in adults.
abstract: The All India Difficult Airway Association (AIDAA) guidelines for management of the unanticipated difficult airway in adults provide a structured, stepwise approach to manage unanticipated difficulty during tracheal intubation in adults. They have been developed based on the available evidence; wherever robust evidence was lacking, or to suit the needs and situation in India, recommendations were arrived at by consensus opinion of airway experts, incorporating the responses to a questionnaire sent to members of the AIDAA and the Indian Society of Anaesthesiologists. We recommend optimum pre-oxygenation and nasal insufflation of 15 L/min oxygen during apnoea in all patients, and calling for help if the initial attempt at intubation is unsuccessful. Transnasal humidified rapid insufflations of oxygen at 70 L/min (transnasal humidified rapid insufflation ventilatory exchange) should be used when available. We recommend no more than three attempts at tracheal intubation and two attempts at supraglottic airway device (SAD) insertion if intubation fails, provided oxygen saturation remains ≥ 95%. Intubation should be confirmed by capnography. Blind tracheal intubation through the SAD is not recommended. If SAD insertion fails, one final attempt at mask ventilation should be tried after ensuring neuromuscular blockade using the optimal technique for mask ventilation. Failure to intubate the trachea as well as an inability to ventilate the lungs by face mask and SAD constitutes 'complete ventilation failure', and emergency cricothyroidotomy should be performed. Patient counselling, documentation and standard reporting of the airway difficulty using a 'difficult airway alert form' must be done. In addition, the AIDAA provides suggestions for the contents of a difficult airway cart.
authors.affiliation: Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Mumbai, Maharashtra, India.
authors.forename: Sheila Nainan
authors.initials: SN
authors.lastname: Myatra
authors.affiliation: Kailash Cancer Hospital and Research Centre, Vadodara Institute of Neurological Sciences, Vadodara, Gujarat, India.
authors.forename: Amit
authors.initials: A
authors.lastname: Shah
authors.affiliation: Department of Anaesthesiology and Critical Care, JIPMER, Puducherry, India.
authors.forename: Pankaj
authors.initials: P
authors.lastname: Kundra
authors.affiliation: Kailash Cancer Hospital and Research Centre, Vadodara Institute of Neurological Sciences, Vadodara, Gujarat, India.
authors.forename: Apeksh
authors.initials: A
authors.lastname: Patwa
authors.affiliation: Department of Anaesthesiology, Kasturba Medical College, Manipal, Karnataka, India.
authors.forename: Venkateswaran
authors.initials: V
authors.lastname: Ramkumar
authors.affiliation: Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Mumbai, Maharashtra, India.
authors.forename: Jigeeshu Vasishtha
authors.initials: JV
authors.lastname: Divatia
authors.affiliation: Department of Anaesthesiology and Critical Care, K S Hegde Medical Academy, Nitte University, Mangalore, Karnataka, India.
authors.forename: Ubaradka S
authors.initials: US
authors.lastname: Raveendra
authors.affiliation: Department of Anaesthesiology and Critical Care, K S Hegde Medical Academy, Nitte University, Mangalore, Karnataka, India.
authors.forename: Sumalatha Radhakrishna
authors.initials: SR
authors.lastname: Shetty
authors.affiliation: Department of Anaesthesiology and Critical Care, J N Medical College and Hospital, AMU, Aligarh, Uttar Pradesh, India.
authors.forename: Syed Moied
authors.initials: SM
authors.lastname: Ahmed
authors.affiliation: Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Mumbai, Maharashtra, India.
authors.forename: Jeson Rajan
authors.initials: JR
authors.lastname: Doctor
authors.affiliation: Department of Anaesthesiology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Dilip K
authors.initials: DK
authors.lastname: Pawar
authors.affiliation: Department of Anaesthesiology, Kanchi Kamakoti Childs Trust Hospital, Chennai, Tamil Nadu, India.
authors.forename: Singaravelu
authors.initials: S
authors.lastname: Ramesh
authors.affiliation: Department of Anaesthesiology, North Bengal Medical College, Darjeeling, West Bengal, India.
authors.forename: Sabyasachi
authors.initials: S
authors.lastname: Das
authors.affiliation: Department of Onco-Anaesthesiology and Palliative Medicine, Dr BRAIRCH, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Rakesh
authors.initials: R
authors.lastname: Garg
keywords: Complete ventilation failure; emergency cricothyroidotomy; pre-oxygenation; supraglottic airway devices; unanticipated difficult intubation