Algorithm of anestesiological assistance in case of unforeseen “difficult” laryngoscopy in elective surgery

  • A. I. Mohylnyk Ukrainian Medical Stomatological Academy
  • M. I. Kravtsiv Ukrainian Medical Stomatological Academy
  • V. I. Liakhovskyy Ukrainian Medical Stomatological Academy
Keywords: “difficult” laryngoscopy, tracheal intubation, laryngeal mask, complications


We analyzed the results of “difficult” laryngoscopy during elective surgery. The rate of successful attempts of adequate ventilation restoration through tracheal intubation (TI), laryngeal mask (LM) as well as complications rate and reason were studied. Effectiveness of repeated attempts of TI decreases progressively. Effectiveness of futher LM application is minimal due to the complications of repeated TI attempts. When alternative algorithm was applied, the effectiveness achieved 94.6%, with almost no complications. Clinical protocol of medical aid in planned anesthesiology is less effective and has a higher complication rate comparing to the only attempt of TI with further application of LM.


1. Janssens M, Hartstein G. Management of Difficult Intubation. Eur J Anesthesiol. 2001;18:3–12.

2. Caplan RA, Posner KL. Medico–legal considerations: The ASA Closed Claim Project. Airway management, principles and practice. St Louis Baltimore: Mosby, 1996;242:1–7.

3. Domino KВ. Airway injury during anesthesia: a closed claims analysis. Anesthesiology. 1999;91(6):1703­11.

4. Cook TM, Scott S, Mihai R. Ligitation related to airway and respiratory complications of anaesthesia: an analysis of claims against the NHS in England 1995–2007. Anaesthesia. 2010;65:556–63.

5. Rose DK, Cohen MM. The incidence of airway problems depends on the definition used. Can J Anaesth. 1996;43:30­4.

6. Brimacombe JR. Laryngeal Mask Anaesthesia. Principles and Practice London: WB Saunders, 2004. 606 p.

7. Paix AD, Williamson JA, Runciman WB. Crisis management during anaesthesia: difficult intubation. Qual Saf Health Care. 2005;14(3):1­6.

8. Practice Guidelines for Management of the Difficult Airway: an updated report by the American Society of Anesthesiologists. Task Force on Management of the Difficult Airway. Anesthesiology. 2003;98:1269­77.

9. Schaeuble JC, Heidegger T. Strategies and algorithms for the management of the difficult airway: An update. Trends in Anaesthesia and Critical Care. 2012;2(5):208–17.

10. Anesteziolohiia i reanimatolohiia, toksykolohiia: Normatyvne vyrobnycho–praktychne vydannia. Kyiv: MNIATs medychnoi statystyky; MVTs «Medinform», 2013:116–9.
How to Cite
Mohylnyk, A. I., Kravtsiv, M. I., & Liakhovskyy, V. I. (2017). Algorithm of anestesiological assistance in case of unforeseen “difficult” laryngoscopy in elective surgery. Klinicheskaia Khirurgiia, (8), 62-64.
General Problems of Surgery