Tracheostomy under local analgesia should always be considered in these patients when major surgery is contemplated and there is any risk of airway compromise postoperatively. In emergency anaesthesia, from the moment of loss of consciousness, cricoid pressure must be maintained. If intubation is impossible, manual ventilation is attempted via a face mask. Pharyngeal secretions are aspirated if necessary. If ventilation is difficult, the patient is allowed to wake up and the situation reassessed.
Many authorities recommend putting the patient head down.
This will increase the risk of regurgitation. Others recommend turning the patient to the left lateral position. This requires that cricoid pressure is maintained as well as manual ventilation which is not always easy in the lateral position especially if airway maintenance is a problem. The Recovery Period Record in the patients notes any difficulty in intubation and the nature of the difficulty . Allow the patient to awaken fully before removing the endotracheal tube.