• Edward Crosby and Alan Lane.
• Department of Anesthesiology, University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada. ecrosby@sympatico.ca
• Can J Anaesth. 2009 Dec 1;56(12):939-59.

PurposeThis article incorporates the following objectives: to review the current evidence regarding the occurrence and management of difficult airways, to outline the role for alternative technology in the management of the difficult airway, to provide a rationale for structured airway rotations in anesthesia residency training, to discuss the barriers to establishing the rotations, to outline issues that must be considered and resolved to enhance these rotations, and to share the experience we have gained over the last decade of offering an airway rotation in the Department of Anesthesiology at the University of Ottawa.Principal FindingsThe incidence of difficult laryngoscopy and intubation has not changed in recent times. Persistent attempts at direct laryngoscopy are associated with low success rates and patient complications. The early use of alternative devices improves the likelihood of success in airway management and reduces the potential for patient injury. Alternative airway management devices are increasingly available to Canadian anesthesiologists, and there is an expectation that anesthesiologists will possess the necessary skills to safely manage the difficult airway with these alternative devices.ConclusionsAnesthesia training programs must provide residents with the skill sets necessary for safe independent practice in airway management. The changes in the scope and reality of residency training have exposed limitations in the traditional mentoring model of residency training; consequently, many programs have responded by offering sub-specialty rotations. In particular, advanced airway management rotations are being offered increasingly to residents in the Canadian training programs. Considerations and strategies to develop and implement a structured airway management program during anesthesia residency are discussed.

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