According to the Difficult Airway Society algorithm, what is the PRIMARY initial step when a difficult airway is anticipated before induction of general anesthesia?

Explanation

## Difficult Airway Management: Anticipated Difficult Airway **Key Point:** When a difficult airway is ANTICIPATED (identified during preoperative assessment), awake intubation techniques are the gold standard to maintain spontaneous ventilation and airway reflexes. **High-Yield:** The Difficult Airway Society algorithm emphasizes that: - **Anticipated difficult airway** → Awake intubation (fiberoptic or videolaryngoscopy) is preferred - **Unanticipated difficult airway** → Plan B, C, D, E maneuvers in sequence **Clinical Pearl:** Awake intubation preserves the patient's ability to maintain their own airway and allows gradual topicalization of the airway, reducing aspiration risk and allowing abort if intubation fails. ### Why Awake Intubation? 1. Maintains spontaneous ventilation 2. Preserves airway reflexes 3. Allows controlled approach under topical anesthesia 4. Permits abandonment if unsuccessful **Mnemonic:** **SAFE AWAKE** = Spontaneous breathing, Airway reflexes preserved, Fiberoptic/videolaryngoscopy, Escape route available, Awake topicalization, Weaning off sedation, Airway secured under direct visualization, Keep spontaneous ventilation, Emergent backup ready. [cite:Difficult Airway Society Guidelines 2015]