Difficult intubation: why warning your anaesthetist can save your life

A “difficult airway” means it may be harder than usual to ventilate you with a mask, place a breathing tube (intubate), or place a rescue airway device. Modern anaesthesia is very safe, but airway problems are among the most time-critical emergencies. When your team knows in advance, they can plan equipment, staffing, and the safest technique.

If you have ever been told “difficult intubation”, “difficult airway”, “grade 3–4 view”, “needed a video scope”, or “awake intubation”, make sure it is clearly documented and disclosed before every anaesthetic. Consider carrying this information on your locked phone using Anonamed.

How do people find out they have a difficult airway?

A previous anaesthetic where intubation was difficult or took multiple attempts.
You were given an “airway alert” letter/card after surgery.
A clinician documented: difficult mask ventilation, difficult laryngeal mask, difficult laryngoscopy, or CICO event.
Head/neck anatomy or conditions that increase difficulty (examples below).

Common reasons an airway is difficult

Anatomy

Small mouth opening / limited jaw movement
Limited neck extension (arthritis, prior fusion)
Large tongue, recessed jaw, facial hair
Obesity / large neck circumference

Medical or surgical history

Head/neck cancer, radiotherapy, airway tumours
Prior airway/neck surgery or trauma
Severe sleep apnoea or stridor
Infection/swelling (e.g., deep neck infection)

Situational factors

Emergency surgery (full stomach, bleeding, sepsis)
Pregnancy (physiologic airway changes, aspiration risk)
Reduced time for preparation (trauma/resuscitation)

What you should tell your anaesthetist (exactly)

What happened: “Difficult intubation” is helpful, but details are better (video scope used, fibreoptic, awake intubation, number of attempts, any complications).
Any airway letter/card: bring it, photograph it, or store it digitally.
Dental issues: loose teeth, caps/veneers, dental implants, bridges.
Breathing symptoms: noisy breathing/stridor, severe reflux, OSA, inability to lie flat.

Why advance warning changes the plan

If difficulty is anticipated, the safest approach may include a senior anaesthetist, additional helpers, specific equipment (video laryngoscope, fibreoptic scope), and sometimes an “awake” technique (keeping you breathing on your own until the airway is secured). The goal is controlled, planned airway management.

Make it available in emergencies

Emergencies happen when you cannot speak for yourself (trauma, stroke, sepsis, cardiac arrest). In those moments, a clear airway history can prevent repeated failed attempts and preventable brain injury from hypoxia.

Practical action: store “DIFFICULT INTUBATION / DIFFICULT AIRWAY” and the key details (what worked, what failed) in a place clinicians can access quickly. A QR-based, privacy-first emergency record on your locked screen (such as Anonamed) is designed for exactly this kind of time-critical information.

Sources for airway management concepts and guidance are listed on the References page (e.g., DAS difficult intubation guidelines).