Avoidance of airway complications requires institutional and individual preparedness, careful assessment, good planning and judgement, good communication and teamwork, knowledge and use of a range of techniques and devices, and a willingness to stop performing techniques when they are failing. All airway management techniques fail and prediction scores are rather poor, so many failures are unanticipated. Unrecognized oesophageal intubation is not of only historical interest and is entirely avoidable. Pulmonary aspiration remains the leading cause of airway-related anaesthetic deaths, most cases having identifiable risk factors. Obesity markedly increases risk of airway complications. Hypoxia is the commonest cause of airway-related deaths. A significant proportion of airway complications occur in Intensive Care Units and Emergency Departments, and these more frequently cause patient harm/death and are associated with suboptimal care.
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The recent 4th National Audit Project of the Royal College of Anaesthetists and Difficult Airway Society provides important detailed information and our best estimates of the incidence of major airway complications. Because these events are rare, most of our learning comes from large litigation and critical incident databases that help identify patterns and areas where care can be improved: but both have limitations.
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Because most airways are easy, most complications occur in easy airways: these complications can and do lead to harm and death. Airway management complications causing temporary patient harm are common, but serious injury is rare.