We recommend against use of albumin in neurosurgical patients. (Strong recommendation, moderate quality evidence)

A powerful suction device (preferably motorized) with a large lumen suction tube (e.g.,Yankauer suction kit) shall be available on the patient during airway management.

Endotracheal intubation shall be performed with a Macintosh blade video laryngoscope.

In patients with a significantly increased risk of aspiration (e.g., ileus, trauma with impaired consciousness), gastric contents shall be aspirated through an existing gastric tube or a large lumen (e.g., 16 Ch) gastric tube placed prior to anesthesia induction, unless contraindicated.

To identify possible predictors of difficult one lung ventilation, clinical examination should be supplemented by the inclusion of radiologic imaging and bronchoscopic findings.

If there are predictors or indications of difficult or impossiblemask ventilation and/or endotracheal intubation in patients for one lung ventilation, the airway shall be secured while maintaining spontaneous breathing.

After placement of the bronchial blocker or transfer to a double-lumen tube, bronchoscopy shall be used to verify correct positioning.

In the absence of anesthetic or surgical contraindications return to spontaneous breathing and extubation shall be attempted immediately after surgery, especially in patients undergoing thoracic surgery.

Preoperative evaluation of the airway for predictors of difficult airway shall also be performed in the outpatient setting.

Patients with a predicted difficult airway, especially those with anatomic (postoperative) airway changes, syndromes, or tumors, shall not be managed as outpatients without access to an inpatient facility.