Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults† C. Frerk, V.S. Mitchell, A.F. McNarry, C. Mendonca,

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Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults† C. Frerk, V.S. Mitchell, A.F. McNarry, C. Mendonca, R. Bhagrath, A. Patel, E.P. O’Sullivan, N.M. Woodall, I. Ahmad British Journal of Anaesthesia Volume 115, Issue 6, Pages 827-848 (December 2015) DOI: 10.1093/bja/aev371 Copyright © 2015 The Author(s) Terms and Conditions

Fig 1 Difficult Airway Society difficult intubation guidelines: overview. Difficult Airway Society, 2015, by permission of the Difficult Airway Society. This image is not covered by the terms of the Creative Commons Licence of this publication. For permission to re-use, please contact the Difficult Airway Society. CICO, can’t intubate can’t oxygenate; SAD, supraglottic airway device. British Journal of Anaesthesia 2015 115, 827-848DOI: (10.1093/bja/aev371) Copyright © 2015 The Author(s) Terms and Conditions

Fig 2 Management of unanticipated difficult tracheal intubation in adults. Difficult Airway Society, 2015, by permission of the Difficult Airway Society. This image is not covered by the terms of the Creative Commons Licence of this publication. For permission to re-use, please contact the Difficult Airway Society. SAD, supraglottic airway device. British Journal of Anaesthesia 2015 115, 827-848DOI: (10.1093/bja/aev371) Copyright © 2015 The Author(s) Terms and Conditions

Fig 3 The laryngeal handshake. (a) The index finger and thumb grasp the top of the larynx (the greater cornu of the hyoid bone) and roll it from side to side. The bony and cartilaginous cage of the larynx is a cone, which connects to the trachea. (b) The fingers and thumb slide down over the thyroid laminae. (c) Middle finger and thumb rest on the cricoid cartilage, with the index finger palpating the cricothyroid membrane. British Journal of Anaesthesia 2015 115, 827-848DOI: (10.1093/bja/aev371) Copyright © 2015 The Author(s) Terms and Conditions

Fig 4 Cricothyroidotomy technique. Cricothyroid membrane palpable: scalpel technique; ‘stab, twist, bougie, tube’. (a) Identify cricothyroid membrane. (b) Make transverse stab incision through cricothyroid membrane. (c) Rotate scalpel so that sharp edge points caudally. (d) Pulling scalpel towards you to open up the incision, slide coude tip of bougie down scalpel blade into trachea. (e) Railroad tube into trachea. British Journal of Anaesthesia 2015 115, 827-848DOI: (10.1093/bja/aev371) Copyright © 2015 The Author(s) Terms and Conditions

Fig 5 Failed intubation, failed oxygenation in the paralysed, anaesthetized patient. Technique for scalpel cricothyroidotomy. Difficult Airway Society, 2015, by permission of the Difficult Airway Society. This image is not covered by the terms of the Creative Commons Licence of this publication. For permission to re-use, please contact the Difficult Airway Society. British Journal of Anaesthesia 2015 115, 827-848DOI: (10.1093/bja/aev371) Copyright © 2015 The Author(s) Terms and Conditions