Tracheal Intubation Awake or Under Anesthesia for Potential Difficult Airway: Look Before You Leap

[...]for patients with adequate facemask ventilation under sevoflurane anesthesia, direct laryngoscopy attempt is allowed and then second decision-marking point of the FDAE approach depends on whether or not laryngoscopic view is adequate. In our view, there are several issues in their study design and findings that deserve attention. Since the main aim of designing the FDAE approach was to assess the ability to obtain adequate facemask ventilation after anesthetic induction in patients with potential difficult airways, supraglottic airway devices were not used as the tools to manage difficult facemask ventilation. [...]the supraglottic airway devices play an important role in the management of patients with difficult airways, as the devices enable ventilation in patients with difficult facemask ventilation and simultaneous use as a conduit for tracheal intubation. [...]this study has excluded the patients who truly require awake tracheal intubation for airway management, such as patients with severe airway obstruction, severe respiratory diseases, and a high risk of aspiration.