2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway

Sep 24, 2026

2022 American Society of Anesthesiologists practice guidelines provide updated, evidence-based recommendations for management of the difficult airway. The document synthesizes current literature, expert and practitioner input, open forum commentary, and feasibility data, and notes that it is not a substitute for local institutional policies or absolute standards. It revises the 2012 report, distinguishes itself via an international task force, and addresses awake airway strategy, oxygenation, equipment updates, and extubation guidance for adult and pediatric patients.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages51

Reading Time2 h 9 min

AccessFree to download

Practice parameters

Abstract

Highlights box

PRACTICE PARAMETERS 2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway* Jeffrey L. Apfelbaum, M. D. , Carin A. Hagberg, M. D. , Richard T. Connis, Ph. D. , Basem B. Abdelmalak, M. D. , Madhulika Agarkar, M. P. H. , Richard P. Dutton, M. D. , John E. Fiadjoe, M. D. , Robert Greif, M. D. , P. Allan Klock, Jr. , M. D. , David Mercier, M. D. , Sheila N. Myatra, M. D. , Ellen P. O’Sullivan, M. D. , William H. Rosenblatt, M. D. , Massimiliano Sorbello, M. D. , Avery Tung, M. D. Anesthesiology 2021; XXX:00–00 ractice guidelines are systematically developed recom PmmakinegnddateciiosinosnsthaabausistheatlthhecpraarectTitionheseerrecandommpatientendatioinns may be adopted, modified, or rejected according to clinical needs and constraints and are not intended to replace local institutional policies. In addition, practice guidelines developed by the American Society of Anesthesiologists (ASA) are not intended as standards or absolute requirements, and their use cannot guarantee any specific outcome. Practice guidelines are subject to revision as warranted by the evolution of medical knowledge, technology, and practice. They provide basic recommendations that are supported by a synthesis and analysis of the current literature, expert and practitioner opinion, open forum commentary, and clinical feasibility data. This document is a revision of the “Practice guidelines for management of the difficult airway: A report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway,” adopted by the ASAin 2012 and published in 2013.1 ABSTRACT The American Society of Anesthesiologists; All India Difficult Airway Association; European Airway Management Society; European Society of Anaesthesiology and Intensive Care; Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care, Learning, Teaching and Investigation Difficult Airway Group; Society for Airway Management; Society for Ambulatory Anesthesia; Society for Head and Neck Anesthesia; Society for Pediatric Anesthesia; Society of Critical Care Anesthesiologists; and the Trauma Anesthesiology Society present an updated report of the Practice Guidelines for Management of the Difficult Airway. (Anesthesiology 2021; XXX:00–00) HIGHLIGHTS BOX These updated guidelines: • Replace the “Practice Guidelines for Management of the Difficult Airway: A Report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway,” adopted by the American Society of Anesthesiologists in 2012 and published in 2013.1 • Specifically address difficult airway management. The guidelines do not address education, training, or certification requirements for practitioners who provide anesthesia and airway management. • Differ from previous guidelines in that they were developed by an international task force of anesthesiologists representing several anesthesiology, airway, and other medical organizations. • Provide new evidence obtained from recent scientific literature along with findings from new surveys of expert consultants, American Society of Anesthesiologists members, and 10 participating organizations. • Provide consideration for the development of a difficult airway management strategy including considerations for awake airway management. • Update equipment for standard and advanced difficult airway management. • Recommend supplemental oxygen administration before initiating and throughout difficult airway management, including the extubation process. • Offer noninvasive and invasive alternatives for difficult airway management. • Emphasize awareness of the passage of time and limiting the number of attempts of different devices and techniques during difficult airway management. • Provide more robust recommendations for extubation of the difficult airway. • Provide new algorithms and infographics for adult and pediatric difficult airway man

FAQs

What is the purpose of these 2022 difficult airway practice guidelines?

They provide updated, evidence-based recommendations for managing the difficult airway. The document emphasizes they are guidance supported by literature synthesis rather than replacement for local institutional policies or absolute requirements.

How do these updated guidelines differ from the 2012/2013 report?

They were developed by an international task force representing multiple anesthesiology and airway organizations, and they incorporate new evidence from recent scientific literature and new surveys of expert consultants and participating organizations.

Which management elements are specifically emphasized for difficult airway care?

The highlights emphasize planning a difficult airway management strategy (including awake airway considerations), supplemental oxygen administration before and throughout management (including extubation), time awareness and limiting attempts, robust extubation recommendations, and both noninvasive and invasive alternatives.

Sep 24, 2026

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