This chapter is written for practitioners working within the perioperative environment that require an understanding of how to assess and manage a patient’s airway. An introduction to airway anatomy highlights relevant anatomical landmarks, and a number of techniques that can be employed for both basic and advanced airway management are described. Airway equipment used by the anaesthetic practitioner will vary depending on requirements of the patient and procedure. Therefore, an overview of both standard and specialist airway equipment available, and how this is used to establish and maintain a patent airway, is provided.

This chapter explores the well-established skill of upper airway endoscopy as a tool for assessing the upper airway and planning the best airway management approach for anaesthesia. It also describes the emerging modality of virtual airway endoscopy, which can examine both upper and lower airway, and its potential roles. Both techniques focus on examination of the air column within the airway (Greenland’s ‘middle column’) but can reach beyond the sight of the naked eye. Both techniques have potential to aid understanding of the patient’s airway anatomy and pathology and can enable improved airway planning.

Failure to properly assess and identify possible difficulties with airway management and incorporate these findings to airway management strategies can lead to a poor clinical outcome. A thorough patient history review and physical examination, including bedside airway assessment, often reveal either congenital or acquired clinical conditions that may affect airway management. Ultrasound, radiographic studies and bedside flexible endoscopy for airway assessment are often necessary to understand the mechanism of pathophysiology of the lower airway. The advancement of technology, such as three-dimensional imaging, cone-beam computer tomography and virtual endoscopy, etc., is resulting in the emergence of potential future airway assessment tools. However, the ideal assessment tool for difficult airway management does not exist and unanticipated difficulties often occur. Using multiple tests to predict difficulty in airway management is better than any single test used in isolation. In addition, adverse human factors can significantly impact airway management. The importance of incorporating cognitive aids in our routine practice cannot be underestimated. Airway assessment forms the first part of any airway management strategy, including the use of certain medications and airway techniques. As practitioners, we must rise to the occasion and perform best clinical practice; there can no longer be a disconnect in what we know and what we do. We need to be the strong link in the chain in providing safe and quality care for our patients.