Advanced Airway Management

Advanced airway management is an airway management strategy that involves extensive skills, advanced training and equipment, and invasive procedures. Advanced airway management aims to develop a clear route between the lungs and the outside source of air, which could be the environment or a machine. Unlike jaw-thrust maneuvers or head tilt/chin lift in basic airway management, advanced airway management involves using advanced devices and state-of-the-art techniques.

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  • Fiberoptic Intubation: It is an important consideration in managing a difficult airway. During general anesthesia, the patients may have difficulty in breathing. This situation should be corrected promptly. However, another method is to perform fiberoptic intubation to maintain respiration when the patient is under general anesthesia.
  • Cricothyroidotomy: Cricothyroid ligament connects the cricoid cartilage and thyroid cartilage. Cricothyroidotomy is a procedure that involves making an incision into the cricothyroid ligament to manage upper airway obstruction due to several situations, such as angioedema, foreign body obstruction, and severe facial trauma. As this procedure is not done often, the surgeon performing it should be well-versed in the technique, relevant anatomy, and equipment used to improve the outcomes. The advantages of cricothyroidotomy compared to tracheostomy include less bleeding, ease, and shorter procedure time.
  • Percutaneous Tracheostomy: Tracheostomy is the procedure that involves tube insertion into the trachea by making an incision. The procedure is performed under general anesthesia. The patient breathes through the tube rather than from the mouth or nose. It is performed in patients with acute respiratory failure requiring long-term airway management. It assists the patients in weaning from the ventilator and lowers the need for sedation. The other conditions that require percutaneous tracheostomy include neurological disease, traumatic brain injury, and upper airway obstruction.


The doctor should evaluate the signs of respiratory failure in the patients. Altered mental status may be present in patients with hypoxia and hypoventilation. Such patients are confused, anxious, and dull and need more force for breathing. Signs that indicate increased force of breathing are cyanosis (bluish skin), tachypnea (rapid breathing), hypopnea (reduced or shallow breathing), and dyspnea (shortness of breath).

Both basic airway management and advanced airway management are life-saving strategies. Some of the differences between both approaches are:

  • The basic airway is less invasive than the advanced airway.
  • A basic airway requires less training than an advanced airway.
  • Equipment used in the basic airway is simple and less complicated, while advanced equipment is used in advanced airway management.

Some of the complications of airway intubation include vocal cord injury, swelling, bleeding, esophageal intubation, and failure of the secured airway.