Awake intubations are alive and well

Excerpt

To my mind, the early 1990s marked the beginning of an era of consciousness in the worldwide anesthesia community to the practice of awake intubation to manage a recognized difficult airway (DA). At that time, the American Society of Anesthesiologists’ (ASA) Task Force held meetings to create an ASA guideline on the management of the DA (ASA-DA-G). The impetus behind the creation of an ASA-DA-G was the finding that more than 85% of all respiratory-related closed malpractice claims involved a brain damaged or dead patient.1 In the very first meeting of the Task Force in 1990, the members realized that awake intubation for patients with recognized DAs would be a key part of the ASA-DA-G. They also understood that it would be prudent to publish a medical intelligence article that explained both the rationale for and the clinical practice of awake intubation, since the concept and practice of awake intubation might be unfamiliar to many practitioners. The subsequent medical intelligence article about the ASA-DA-G was published in Anesthesiology in 1991,2 and the ASA-DA-G itself was later published in 1993.3 Interestingly, a Canadian guideline on the management of the DA, which also recommends awake intubation for the patient with a known DA, was not published until 2013.4 …