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New guidelines to help make anaesthesia safer

New guidelines to help make anaesthesia safer

New guidelines published on 15 November 2019, in the journal Anaesthesia, will help anaesthetists perform safer airway management for patients undergoing general anaesthesia.

In the UK, anaesthetists are responsible for delivering 3–5 million general anaesthetics each year.1 One of the primary goals of anaesthesia is to ensure an adequate supply of oxygen to vital organs, such as the brain. To do this, anaesthetists ‘manage the patient’s airway’ in a variety of ways – by holding on a face mask, placing a mask just over the opening to the lungs, or by passing a tube into the trachea (windpipe). Some patients have airways that are difficult to manage for a range of reasons and in these situations managing the airway before being asleep (under general anaesthesia) is the safest thing to do. These new guidelines, the first of their kind worldwide, aim to encourage more anaesthetists to manage a patient’s airway before they have been anaesthetised. This technique, known as Awake Tracheal Intubation (ATI) is low risk and avoids the consequences of difficult airway management in an anaesthetised patient.

Difficult airway management is estimated to occur in 100,000 patients per year,2 and many patients are thought to die or suffer permanent brain damage because of complications in managing the airway. The ATI technique can reduce this risk. Despite the high success rate and safety profile of the ATI technique, it is often underused, often due to a lack of training, experience or confidence.

These new ATI guidelines aim to standardise the training and practice of this technique, benefitting thousands of patients a year who would otherwise be at risk of complications.

Dr Kariem El-Boghdadly, Secretary of the guidelines group and Consultant Anaesthetist at Guy’s and St Thomas’ NHS Foundation Trust in London, said: “These new guidelines aim to make this important technique more available to all patients by providing direct guidance on how to safely manage at-risk patients. In the long-term we hope that this will improve the care of patients undergoing surgery anywhere in the world.”

Dr Imran Ahmad, Chairperson of the guidelines group, Consultant Anaesthetist at Guy’s and St Thomas’ NHS Foundation Trust and Honorary Secretary for the Difficult Airway Society said: “The Difficult Airway Society has a long tradition of producing guidelines that increase patient safety; we hope these guidelines will continue this tradition by encouraging anaesthetists to perform this technique when indicated and avoid potential complications in at-risk patients.”

Read the guidelines in Anaesthesia


 1 Abbott TEF, Fowler AJ, Dobbs TD, Harrison EM, Gillies MA, Pearse RM. Frequency of surgical treatment and related hospital procedures in the UK: a national ecological study using hospital episode statistics. Br J Anaesth. 2017 Aug 1;119(2):249-257.

 2 Cook TM, Woodall N, Frerk C; Fourth National Audit Project. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: anaesthesia. Br J Anaesth. 2011 May;106(5):617-31.