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Coronavirus Disease 2019 (COVID-19), caused by a novel coronavirus (SARS-CoV-2), is a highly contagious disease. It firstly appeared in Wuhan, Hubei province of China in December 2019. During the next two months, it moved rapidly throughout China. Most of the infected patients have mild symptoms including fever, fatigue and cough, but in severe cases, patients can progress rapidly and develop into acute respiratory distress syndrome, septic shock, metabolic acidosis and coagulopathy. The new coronavirus was reported to spread via droplets, contact and natural aerosols from human to human. Therefore, aerosol-producing procedures such as endotracheal intubation may put the anesthesiologists at high risk of nosocomial infections. In fact, SARS-CoV-2 infection of anesthesiologists after endotracheal intubation for confirmed COVID-19 patients have been reported in hospitals in Wuhan. The expert panel of airway management in Chinese Society of Anaesthesiology has deliberated and drafted this recommendation, by which we hope to guide the performance of endotracheal intubation by frontline anesthesiologists and critical care physicians. During the airway management, enhanced droplet/airborne personal protective equitment (PPE) should be applied to the health care providers. A good airway assessment before airway intervention is of vital importance. For patients with normal airway, awake intubation should be avoided, and modified rapid sequence induction is strongly recommended. Sufficient muscle relaxant should be assured before intubation. For patients with difficult airway, good preparation of airway devices and detailed intubation plans should be made. [ABSTRACT FROM AUTHOR]

Background: Abnormal laryngeal structures are likely to be associated with a difficult laryngoscopy procedure. Currently, laryngeal structures can be measured by ultrasonography, however, little research has been performed on the potential role of ultrasound on the evaluation of a difficult laryngoscopy. The present study investigated the value of laryngeal structure measurements for predicting a difficult laryngoscopy. Objective: The main objective of this study was to explore the value of laryngeal structure measurements for predicting a difficult laryngoscopy. Methods: Two hundred and eleven adult patients (over 18 years old) were recruited to undergo elective surgery under general anesthesia via endotracheal intubation. Ultrasound was utilized to measure the distance between the skin and thyroid cartilage (DST), the distance between the thyroid cartilage and epiglottis (DTE), and the distance between the skin and epiglottis (DSE) in the parasagittal plane. These metrics were then investigated as predictors for classifying a laryngoscopy as difficult vs easy, as defined by the Cormack and Lehane grading scale. Results: Multivariate logistic regression showed that the DSE, but not DST or DTE, was significantly related to difficult laryngoscopies. Specifically, a DSE ≥ 2.36 cm predicted difficult laryngoscopies with a sensitivity and specificity of 0.818 (95% CI: 0.766–0.870) and 0.856 (95% CI: 0.809–0.904). Furthermore, when combining the best model constructed of other indicators (i.e. sex, body mass index, modified Mallampati test) to predict the difficult laryngoscopy, the AUC reached 93.28%. Conclusion: DSE is an independent predictor of a difficult laryngoscopy; a DSE cutoff value of 2.36 cm is a better predictor of a difficult laryngoscope than other ultrasound or physiological measurements for predicting a difficult laryngoscope. Nevertheless, it's more valuable to apply the best model of this study, composed of various physiological measurements, for this prediction purpose. [ABSTRACT FROM AUTHOR]

Background: The 2022 ASA guidelines recommend the video laryngoscope, video stylet, and flexible videoscope as airway management tools. This study aims to compare the efficacy of three airway devices in intubating patients with difficult airways., Methods: A total of 177 patients were selected and randomized into the following three groups: the video laryngoscope group (Group VL, n = 59), video stylet group (Group VS, n = 59), and flexible videoscope group (Group FV, n = 59). The success rate of the first-pass intubation, time of tracheal intubation, level of glottic exposure, and occurrence of intubation-related adverse events were recorded and analyzed., Results: All patients were successfully intubated with three devices. The first-pass intubation success rate was significantly higher in Groups VS and FV than in Group VL (96.61% vs. 93.22% vs. 83.05%, P < 0.01), but it was similar in the first-pass intubation success rate between Groups VS and FV(P > 0.05). The number of patients categorized as Wilson-Cormack-Lehane grade I-II was fewer in Group VL than in Groups VS and FV (77.97% vs. 98.30% vs. 100%, P = 0.0281). The time to tracheal intubation was significantly longer in Group FV(95.20 ± 4.01) than in Groups VL(44.56 ± 4.42) and VS(26.88 ± 4.51) (P < 0.01). No significant differences were found among the three groups in terms of adverse intubation reactions (P > 0.05)., Conclusions: In patients with difficult airways requiring intubation, use of the video stylet has the advantage of a relatively shorter intubation time, and the flexible videoscope and video stylet yield a higher first-pass intubation success rate and clearer glottic exposure than the use of the video laryngoscope., Trial Registration: Chinese Clinical Trial Registry. No: ChiCTR2200061560, June 29, 2022., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Introduction: Difficult airway management is closely related to the safety and quality of medical care. However, the low incidence of correct prediction of difficult airway in clinical screening tests presents physicians with a dilemma. Depressed airway neuromuscular tension during sleep and anaesthesia tends to cause collapse of fragile parts of the upper airway. Although previous studies have confirmed that anterior cervical tissue thickness is associated with difficult airways, there is no evidence to support a correlation between a difficult airway and specific patterns or findings of anaesthesia-induced airway collapse. Thus, this study aims to examine changes in airway dimensions before and after induction of general anaesthesia to explore whether it could provide useful information regarding the specific anatomic changes occurring which may cause difficult airways., Methods and Analysis: This will be a single-centre prospective observational single-blinded study, conducted in a tertiary teaching hospital in Guangzhou, China. Subjects will be recruited from patients (aged 18-65 years) scheduled for elective surgery under general anaesthesia. Sonographic measurement will be performed to detect changes in the thickness of the anterior cervical soft tissue before and after anaesthetic induction. Based on the resulting data distribution, analyses will initially compare these changes using a paired t-test or the Wilcoxon signed-rank test. The correlation of sonographic changes and Cormack-Lehane grade will be evaluated by using receiver-operating characteristic curves to detect the sensitivity and specificity of a measurement for detecting difficulties. Linear stepwise regression analysis will be used to assess the correlation between airway changes and demographic variables as well as clinical tests., Ethics and Dissemination: Ethical approval has been obtained from the Ethics Committee of the First Affiliated Hospital of Guangzhou University of Chinese Medicine (ZYYECK (2018) 041). The results will be disseminated through conference presentations, professional journals and peer-reviewed publications., Trial Registration Number: ChiCTR1900021123; Pre-results., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)