Date of Award


Document Type

Open Access Thesis

Degree Name

MS in Physician Assistant Studies (PA)


Physician Assistant Studies

First Advisor

Erik Van Heck


The objective of this thesis is to analyze existing literature and guidelines for difficult intubations and provide clinical recommendations. This paper is a retrospective analysis of human trials focusing on preparation, medication, and tools in the field of emergency airway management. Techniques will be described and discussed. A large portion of intubations are described as difficult and have the potential to fail. Articles retrieved from databases PubMed, Medline, and PLOS ONE and the search engine Google Scholar were reviewed. Websites for the institutions of the American Society of Anesthesiologists and Difficult Airway Society were used in guidance. Currently, many guidelines exist for difficult intubation, and traditional bedside prediction has proven to be unreliable. Techniques such as preprocedural checklists, preoxygenation, proper positioning benefit all intubations. In addition, practicing the failed intubation protocol including a standardized tracheotomy procedure is recommended. The paralytic rocuronium may be superior to succinylcholine in critically ill or those likely to have difficult airways. Technologies such as video laryngoscope, supraglottic airway devices, and bougie-first intubation should be included in training and implemented in practice. The obese population may have specific changes to technique to reduce the risk of complications. Finally, cricoid pressure is theoretically beneficial but practically challenging to replicate and recommendations will be given regarding its implementation.


SC 11.PAS.2020.Kitzmann.N