Navigating the complexities of the physiologically difficult airway is a critical challenge in modern anesthesiology. This paper delves into the recent literature, spotlighting the persistent risks of adverse events such as desaturation and cardiovascular collapse during intubation, particularly in patients with pre-existing physiological compromise. It examines the epidemiology, associated risks, and management strategies, emphasizing the importance of optimizing induction agents and preoxygenation. While first attempt success is crucial, many patients remain at high risk, even with these measures in place. Studies over the past five years have explored various aspects of this high-stakes clinical scenario, offering insights into modifiable risk factors. The research underscores that successful intubation hinges on vigilance and preparedness for unexpected complications. The work highlights the need for advanced planning and management, including optimizing modifiable risks prior to intubation, yet there are limitations to achieving this in a complex clinical environment. Future studies should focus on developing innovative strategies to further mitigate these risks and improve patient outcomes.
Published in Current Anesthesiology Reports, this paper aligns with the journal's focus on providing concise reviews of current topics in anesthesiology. By evaluating recent literature on the physiologically difficult airway, the paper contributes to the journal’s goal of keeping practitioners informed about the latest advancements and management considerations in this critical area, ultimately aiming to improve patient safety and outcomes.