An airway cannot be passed or an airway is passed but a patient cannot be ventilated through the airway. The patient cannot self ventilate because of the paralytic agent. The patients dies. Alternatively, the patient is successfully ventilated ultimately but suffers severe brain damage because of the interval of apnea. First and foremost, it is the anesthesiologist's responsibility during the course of a pre-operative anesthesia evaluation to assess the likelihood that a difficult airway will be encountered.
Prior records are to be examined and a careful history is to be taken.
There is a wide array of frequently encountered physical anomalies, which can be assessed and identified during the course of the pre-anesthesia evaluation. For a patient in whom a difficult intubation is anticipated, a specific strategy must be developed for how the difficult airway will be managed. One alternative, when a difficult airway is anticipated prior to a surgical procedure, is to not perform the surgical procedure or to perform it under regional or other form of anesthesia. In Pennsylvania a patient's consent to anesthesia, where the patient has a difficult airway, cannot be informed consent, if the patient is not made aware of the hazards of proceeding with the surgery in the face of a difficult airway. In one of every ten thousand inhalation anesthesias an intubation effort fails and a patient cannot be ventilated and dies.