Awake Tracheal Intubation Clinical Practice Guidelines (2019)

Difficult Airway Society (DAS)

This is a quick summary of the guidelines without analysis or commentary. For more information, go directly to the guidelines by clicking the link in the reference.

November 27, 2019

The guidelines on awake tracheal intubation were released on November 14, 2019, by the Difficult Airway Society (DAS).[1]

Awake tracheal intubation must be considered in the presence of predictors of difficult airway management.

A cognitive aid (eg, a checklist) is recommended before and during performance of awake tracheal intubation.

Supplemental oxygen should always be administered during awake tracheal intubation.

Effective topicalization must be established and tested. The maximum dose of lidocaine should not exceed 9 mg/kg lean body weight.

Cautious use of minimal sedation can be beneficial. This should ideally be administered by an independent practitioner. Sedation should not be used as a substitute for inadequate airway topicalization.

The number of attempts should be limited to three, with one further attempt by a more experienced operator (3 + 1).

Anesthesia should be induced only after a two-point check (visual confirmation and capnography) has confirmed correct tracheal tube position.

All departments should support anesthetists to attain competency and maintain skills in awake tracheal intubation.

For more information, please go to Video Laryngoscopy and Fiberoptic-Assisted Tracheal Intubation and Lighted Stylet Assisted Tracheal Intubation.

For more Clinical Practice Guidelines, please go to Guidelines.


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