ANESTHESIOLOGY FAST REVIEW

ANESTHESIOLOGY_FAST_REVIEWKAPAK1-0-25

INTRAOPERATIVE AIRWAY MANAGEMENT AND MAIN INVASIVE PROCEDURES

Semih Başkan

Ankara Bilkent City Hospital, Department of Anesthesiology and Reanimation, Ankara, Türkiye

Başkan S. Intraoperative Airway Management and Main Invasive Procedures. In: Kazancı D, editor. Anesthesiology Fast Review. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.199-210.

ABSTRACT

  • Airway management is one of the basic components of the intraoperative period in anesthesia practice. Using traditional and modern assessment techniques together can increase the effectiveness of intraoperative airway management by determining possible airway difficulties and establishing an appropriate strategy.
  • The basic elements of preoperative assessment are detailed patient history, physical examination, and predictive tools. In particular, previous anesthesia complications and comorbidities such as obstructive sleep apnea should be questioned in the patient’s anamnesis. In physical assessment, criteria such as Mallampati classification, thyromental distance, and neck mobility are used.
  • However, simple assessment methods are usually limited in terms of sensitivity and specificity; therefore, they are supported by additional systems such as Wilson, and LEMON score. However, the complexity of these systems limits their routine use.
  • Advances in technology have increased the success rate in airway management. Modern imaging methods such as CT, MRI, and ultrasound allow precise visualization of anatomical structures.
  • Noninvasive and relatively low-cost preoperative airway ultrasound is increasingly preferred due to its portability and high diagnostic accuracy of skin-to-epiglottic and hyomental distance ratios. In addition, 3D modeling and printing techniques offer customized solutions for patients with anatomical abnormalities, improving preoperative planning in complex cases.
  • Artificial intelligence (AI) is increasingly used in airway assessment, integrated with modern devices and increasing accessibility through mobile applications.
  • Today, modern airway management increasingly relies on tools such as video laryngoscopy and fiberoptic bronchoscopy. These developments have reduced the use of techniques such as retrograde intubation.
  • Invasive airway procedures are critical when noninvasive techniques are inadequate. Tracheostomy, cricothyrotomy, and bronchoscopy are invasive procedures with specific indications and application methods.
  • By integrating advanced tools with traditional techniques and considering patient-based factors, anesthesiologists can significantly improve perioperative safety and efficiency. In the future, advances in AI, advanced imaging modalities, and predictive modeling are expected to further enhance airway management and set new standards in anesthesiology practice.

Keywords: Airway management; Tracheostomy; Bronchoscopy; Preoperative period

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