As part of the airway examination, anatomic and physiologic indications for difficult mask ventilation and intubation shall be evaluated:Mouth opening, dental status, mandibular protrusion, cervical spine mobility, pathol_x005Fogy (neck, face), known difficult airway, consideration of imaging and ENT findings as appropriate.

There shall be an algorithm/standard within each institution that defines the procedurefor airway management when predictors for a difficult airway are present. Scores can be used.

Preanesthetic ultrasound of the airway may be helpful in identifying difficult airway man_x005Fagement. To assess the risk of aspiration, point-of-care ultrasound can be used to determine the filling status of the stomach.

Ultrasound examination of the trachea and lungs can provide evidence for correct tube position.

Spontaneously breathing patients shall be preoxygenated prior to induction of anesthe_x005Fsia. This should be performed using a tight-fitting face mask with 100% oxygen and a fresh gas flow of 10 L for at least 3–4min. Alternatively, the patient shall take eight deep breaths at the same oxygen flow for a maximal duration of 60 s.

In the absence of a difficult airway a planned neuromuscular blockade shall be performed immediately after achieving adequate depth of anesthesia without checking for a sufficient mask ventilation.

Cuff pressure for supraglottic airways shall be measured after placement and shall not ex_x005Fceed 60 cmH2O.

Intubation shall only be attempted without a flexible intubation endoscope if the opera_x005Ftor has the necessary expertise and is using an SGA that has a high success rate when used correctly.

Emergency use should be reserved for those with sufficient experience in patient use.

For direct laryngoscopy, positioning in the sniffing position can be helpful for a better view.