An anaesthetist may control the airway through the application of several methods and the use of specific equipment. Primarily, the patient’s position must be optimised to allow for an open airway. An appropriate face mask should be fitted around the patient’s mouth ensuring there are no leaks. In the case of an obstructed upper airway the use of oral or nasal devices, such as a Guedel or nasopharyngeal airway, can allow the obstruction to be bypassed and aid effective oxygenation. Supraglottic airway devices (SADs), such as the laryngeal mask or i-gel, are frequently used to provide oxygenation and ventilation in spontaneously breathing patients and form part of the difficult airway algorithm. A variety of devices and generations are now available which have additional benefits of allowing gastric content suction and the passage of flexible scopes to visualise the airway and aid intubation. The tracheal tube is discussed with all its features and benefits of allowing for a definite and secure airway.

A difficult or failed intubation may occur in the elective or emergency setting, and it is therefore important that every anaesthetist has a plan and knows the failed intubation algorithm. The Difficult Airway Society (DAS) in the UK have published guidelines on the management of failed tracheal intubation which are discussed in this chapter, also described as the ‘Can’t intubate, can’t ventilate’ algorithm. The algorithm follows a stepwise approach starting with Plan A the goal to achieve tracheal intubation and how this may be optimised. Plan B describes the use of supraglottic airway devices to allow for oxygenation when intubation has not succeeded. Plan C advises the clinician to return to facemask ventilation in the case of failed oxygenation and consider waking up the patient if circumstances allow. Plan D describes emergency front-of-neck asses using a scalpel cricothyroidotomy approach.

Airway management and failed intubation in the pregnant woman present unique challenges which differ from the non-pregnant patient. The provision of general anaesthesia in the obstetric population requires additional considerations of the physiological changes in pregnancy, environmental factors and the safe outcome of mother and baby. Appropriate team planning, preparation and performance of rapid sequence induction should be carried out in order to help to reduce adverse airway events. The OAA/DAS guidelines are designed to help to standardise teaching, reduce the incidence of failed intubation and give guidance on further management should failed intubation occur.