The virus responsible for the coronavirus-19 pandemic is predominantly spread by droplet and contact routes of transmission. Many airway management interventions, particularly when applying positive pressure to the airway, generate aerosol particles which pose a further risk of airborne viral transmission. The fundamental principles of airway management in the setting of a respiratory epidemic are not changed but it is essential to maximise safety for both the patient and all staff involved in caring for them. The airway manager should fully understand and apply principles of infection prevention and control, including understanding and matching personal protective equipment (PPE) to the prevailing mode of viral transmission. Airway management should be meticulously planned, safe for the patient and staff, be undertaken by skilled operators using reliable, well-practised techniques and should aim to achieve high first-attempt success rates so that securing the airway is timely and swift.

Supraglottic airways (SGAs) have been part of core anaesthetic practice for approximately 30 years, since the introduction of the classic laryngeal mask which is described in some detail. In many countries an SGA is now used for airway management for the majority of anaesthetics. Optimal use and insertion technique are described. The range of SGAs available and their roles have expanded dramatically in this time. Second generation SGAs are those designed to reduce the risk of aspiration and are emphasised in this chapter. With the wide range of SGAs available it can be problematic to decide which device to use and this is especially so as the boundaries of acceptable use are ever widened. This chapter describes those devices with the greatest versatility and utility – arguably also with the greatest safety profile too – and some newer devices. SGAs have a major role to play in advanced and difficult airway management. The use of an SGA as a rescue device and as a conduit for intubation during management of the difficult airway is described in detail.

Videolaryngoscopes have been in existence for several decades but in the last decade have taken a central role in both difficult and routine airway management. During that time videolaryngoscopy has not only become embedded in most difficult airway algorithms but the technique has become part of core airway management skills and the use of awake videolaryngoscopy has increased. This chapter describes the various types of videolaryngoscopes, their roles, strengths and limitations. Strategies to optimise use of Macintosh and hyperangulated devices are described as well as which adjuncts are best suited to their use. The issue of ‘can see, cannot intubate’ is discussed along with techniques to overcome it. The role of videolaryngoscopy outside the operating theatre, in critical care, in the emergency department and in pre-hospital care is discussed in this and other chapters.

Despite the training and skills of airway managers, airway management complications still occur and may cause patient harm or death. The causes are multifactorial and may include patient, environment and clinician factors. Airway complications likely contribute to a significant proportion of deaths due to anaesthesia and are certainly more common outside the operating theatre and especially in the critical care unit. Reported incidences of failure and harm during airway management vary depending on the population studied and definitions used. Numbers may be of less value than understanding themes that help us improve care and reduce harm. The chapter emphasises that conventional research (e.g. device evaluation studies and randomised controlled trials) may be of little use in identifying low frequency events and complications because of their restricted inclusion and exclusion criteria, the use of devices only by experts and in conventional settings and because of their focus on efficacy rather than safety. The chapter highlights the important and growing role of registries and databases. Several are described in detail including the 4th National Audit Project and the Dutch ‘mini-NAP’. The value and limitations of litigation databases are explored. Specific complications of note are described at the end of the chapter.