Zusammenfassung Die Einführung der Lungenkrebsfrüherkennung als Leistung der gesetzlichen Krankenversicherung wird zu einer steigenden Zahl diagnostischer und interventioneller Bronchoskopien führen, um eine frühzeitige Therapieeinleitung und verbesserte onkologische Outcomes zu ermöglichen. Damit wächst die Bedeutung evidenzbasierter anästhesiologischer Konzepte zur Sicherstellung von Patientensicherheit und Prozedurerfolg.Dieser Übersichtsartikel fasst aktuelle anästhesiologische Strategien, Oxygenierungs- und Beatmungskonzepte sowie Monitoringverfahren in der interventionellen Bronchoskopie zusammen und bewertet deren klinische Evidenz hinsichtlich Sicherheit, Risiken und Ergebnisqualität.Während die diagnostische Bronchoskopie häufig unter Lokalanästhesie und moderater Sedierung durchgeführt wird, erfordert die moderne interventionelle Bronchoskopie ein individualisiertes anästhesiologisches Management. Komplexe und invasive Verfahren wie transbronchiale Kryobiopsien, endobronchiale Tumorablationen oder Stentimplantationen stellen erhöhte Anforderungen an Analgosedierung, Atemwegssicherung sowie Oxygenierungs- und Beatmungsstrategien. Der geteilte Atemweg erfordert eine enge interdisziplinäre Zusammenarbeit zwischen interventionellem und anästhesiologischem Team sowie die kontinuierliche Aufrechterhaltung von Oxygenierung und Ventilation während der gesamten Prozedur.Das Spektrum anästhesiologischer Verfahren reicht von Analgosedierung bis zur Allgemeinanästhesie mit Muskelrelaxation. Zur Atemwegssicherung stehen augmentierte Spontanatmung, supraglottische Atemwegshilfen, endotracheale Techniken, starre Bronchoskopie sowie Katheter zur Jet-Ventilation zur Verfügung. Etablierte Oxygenierungs- und Beatmungsformen umfassen konventionelle Sauerstoffapplikation nasale „High-Flow“-Sauerstofftherapie (HFNO), konventionelle Beatmung und Jet-Ventilation, die abhängig von Intervention und Patientenprofil kombiniert eingesetzt werden können.Individuell adaptierte Anästhesiekonzepte sind entscheidend für die Reduktion prozeduraler Komplikationen und den Erfolg interventioneller Bronchoskopien. Sie erfordern eine strukturierte präinterventionelle interdisziplinäre Evaluation sowie standardisierte periinterventionelle Strategien. Die Wahl des Anästhesieverfahrens sollte patienten- und prozedurspezifisch unter Berücksichtigung von Komorbiditäten, Atemwegs- und Lungenpathologie sowie Invasivität und Dauer der Intervention erfolgen.

Abstract:As lung cancer screening is now covered by statutory health insurance and with the goal of early cancer detection, the number of diagnostic and interventional bronchoscopic procedures is expected to increase substantially - in order to facilitate timely treatment and improve patient survival. This trend underscores the growing importance of evidence-based anaesthesiological management in interventional bronchoscopy.This review summarises current anaesthetic strategies, oxygenation and ventilation techniques, and the monitoring modalities used in interventional bronchoscopy. The review critically appraises the available evidence regarding safety, risk profiles, and procedural outcomes.While diagnostic bronchoscopy is commonly performed under local anaesthesia, with or without moderate sedation to improve patient comfort, modern interventional bronchoscopy imposes significantly higher demands on anaesthetic care. Increasingly complex and invasive procedures, such as transbronchial cryobiopsy, airway stent implantation, and endobronchial tumour ablation, require tailored approaches to analgesia, anaesthesia, airway management, and respiratory support, in order to ensure procedural success and patient safety. The shared airway necessitates close interdisciplinary collaboration and the continuous maintenance of adequate oxygenation and ventilation throughout the intervention.Anaesthetic strategies range from various levels of procedural sedation to general anaesthesia with neuromuscular blockade. Airway management options include augmented spontaneous breathing, supraglottic airway devices, infraglottic techniques such as rigid bronchoscopy, endotracheal tubes, and specialised catheters for jet ventilation. In addition to conventional oxygen supplementation, established respiratory support modalities include high-flow nasal oxygen therapy, controlled mechanical ventilation, and jet ventilation, which may be selected or combined - depending on procedural and patient-specific requirements.Individually adapted anaesthetic concepts are essential for minimising procedural complications and optimising outcomes. This requires structured pre-interventional interdisciplinary evaluation and the implementation of standardised peri-interventional strategies. The choice of anaesthetic technique should be individualised, considering patient-related risk factors, comorbidities, underlying pulmonary pathology, and the type and invasiveness of the bronchoscopic procedure.

Abstract Purpose Obstructive sleep apnea (OSA) is associated with an increased risk of postoperative complications. However, data on the relationship between previously undiagnosed high-risk patients and postoperative outcomes remain limited. The study aimed to evaluate the association between OSA risk-assessed using the STOP-Bang score (SBS) and the Step-2 scoring strategy – and the incidence of postoperative complications as well as prolonged hospital length of stay. Methods A total of 4,292 adult patients undergoing elective, non-cardiac surgery between 2015 to 2016 were included. All patients underwent preoperative assessment for OSA risk using the STOP-Bang score questionnaire and the Step-2 algorithm. Patients were stratified into low-risk (SBS 0—2) and high-risk (HR) groups, defined as either (SBS 5—8 (S1HR) or Step-2 high-risk (S2HR). The primary outcome was the occurrence of major postoperative complications. Secondary outcomes included prolonged hospital length of stay. Results Patients classified as high-risk for OSA exhibited a significant increased risk of major postoperative complications compared with the low-risk group (odds ratio [OR]: 1.65 (95% CI 1.09—2.48); S2HR vs. low-risk: OR 2.17 (95% CI 1.57—3.01). No significant difference in complications risk was observed between the two high-risk stratification methods (OR 0.96 (95% CI 0.64—1.33; P = 0.8). Similarly, high-risk patients were more likely to experience prolonged hospital stays (OR 1.34, 95% CI 1.02—1.76; P = 0.003 for S1HR; OR 1.54, 95% CI 1.29—1.87; P = 0.01 for S2HR), with no significant difference between the high-risk groups (OR 1.03, 95% CI 0.79—1.34; P = 0.7). Conclusions A high-risk for OSA, as identified by either the STOP-Bang or Step-2 assessment tools, is independently associated with an increased risk of postoperative complications and prolonged hospital length of stay. Both screening strategies demonstrated comparable predictive performance. These findings underscore the value of structured preoperative screening in identifying patients with a high likelihood of previously undiagnosed OSA and in guiding perioperative risk stratification and postoperative management.

OBJECTIVES:We hypothesized that advanced 3-dimensional (3D) echocardiographic assessment of mitral annular dimensions provides a more accurate correlation of surgically implanted annuloplasty ring size compared with conventional 2-dimensional (2D) echocardiography. DESIGN:Prospective, non-interventional study SETTING: Operating room at a tertiary academic medical center PARTICIPANTS: Ninety-nine patients METHODS: Transesophageal echocardiography was performed in patients undergoing surgical mitral valve repair. The 3D datasets of the mitral valve were analyzed using dedicated software for semiautomated measurement (4D MVA; TOMTEC Imaging Systems, Germany). Additionally, mitral annular dimensions were evaluated using conventional 2D images, as well as images derived from multiplanar reconstruction of 3D datasets (3D MPR). Pearson correlation coefficients between echocardiographic measurements and the intraoperatively selected annuloplasty ring size were compared. MAIN RESULTS:The strongest correlations with annuloplasty ring size were observed for the mid-systolic anterolateral-posteromedial diameter in 4D MVA (r = 0.706), the end-systolic anterior-posterior diameter in 2D (r = 0.600), and the end-systolic anterior-posterior diameter in 3D MPR (r = 0.662). In the overall cohort, there was no statistically significant difference between the highest correlation coefficients of each imaging modality (4D MVA v 2D; p = 0.059). However, a post hoc comparison including all measurement parameters demonstrated a significant difference between 4D MVA and 2D. Furthermore, subgroup analysis of the Corcym Memo 4D ring model revealed a significant difference (p < 0.001) between the highest correlation coefficients derived from 4D MVA and 2D. CONCLUSION:Software-based 3D echocardiographic assessment (4D MVA) of the mitral annulus geometry might provide superior accuracy for predicting appropriate annuloplasty ring size compared with conventional 2D measurements, supporting its role in individualized decision-making.

OBJECTIVES:Acute kidney injury (AKI) is a relevant complication after transcatheter aortic valve replacement (TAVR). Venous congestion is recognized as a contributor to perioperative organ dysfunction. The Venous Excess Ultrasound Score (VExUS) provides a noninvasive assessment of systemic venous congestion. This study hypothesized that a higher pre- or postprocedural VExUS is associated with an increased risk of AKI following TAVR. DESIGN:Retrospective register study. SETTING:Two cardiovascular centers performing transcatheter aortic valve replacement. PARTICIPANTS:A total of 101 patients were included. INTERVENTIONS:Periprocedural point-of-care ultrasound examinations were performed to assess venous congestion using the VExUS before and 6 hours after TAVR. MEASUREMENTS AND MAIN RESULTS:In total, 101 patients with aortic stenosis undergoing TAVR underwent periprocedural point-of-care ultrasound to assess systemic venous congestion using the VExUS before and 6 hours after the procedure. Patients were stratified according to the presence of venous congestion (VExUS ≥1). The primary endpoint was the occurrence of AKI within 7 days after TAVR or before hospital discharge, defined according to Kidney Disease: Improving Global Outcomes criteria. The median age was 84 years (interquartile range, 80-87), 47% of patients were female, and 18% developed AKI after TAVR. A VExUS grade ≥1 was observed in 73% of patients preprocedurally and in 54% at 6 hours postprocedure (p < 0.002). Receiver operating characteristic analysis demonstrated modest discrimination for preprocedural VExUS (area under the curve [AUC], 0.62; 95% CI, 0.49-0.75) and excellent discrimination for postprocedural VExUS (AUC, 0.97; 95% CI, 0.95-1.00). A VExUS grade ≥2 was strongly associated with AKI after TAVR, with a sensitivity of 100% and a specificity of 88% (p < 0.0001). CONCLUSIONS:Venous congestion appears to contribute to AKI in patients undergoing TAVR. The VExUS may serve as a noninvasive tool for early risk stratification of AKI, supporting a potential role of venous congestion in its pathophysiology.

INTRODUCTION:Sedation during flexible bronchoscopy can be administered by a second physician, an anesthesiologist or as nurse-administered sedation (NAS). Propofol is often administered by non-anesthesiologists. It is unclear whether complications differ with various sedation protocols. METHODS:We searched PubMed for clinical trials of sedation during bronchoscopy and conducted a systematic review of complications (death ≤24 h post-procedure or intensive care unit (ICU) admission/predefined cardiopulmonary escalation [CPE]). Outcomes were analyzed according to the staff administering sedation, complexity of procedure, for propofol-containing regimes, and the ASA physical status classification of the patient. RESULTS:This analysis (120 articles, 39,475 procedures) showed a mortality rate of 0.01% for sedation bronchoscopy. ICU admission rate was 0.12%, and CPE was reported in 0.57%. Significantly higher CPE was recorded for anesthesiologists compared to NAS and second physicians (1.16% vs. 0.65% vs. 0.07%, respectively, p < 0.001) with higher ICU admission for NAS compared to anesthesiologists and second physicians (0.35% vs. 0.00% vs. 0.03%, respectively, p < 0.001). Endobronchial ultrasound did not increase complication rates. Admission to ICU and CPE remained <1% in propofol-containing regimes, although complications were slightly lower without propofol. Comparison of lower risk ASA 1-2 studies compared to studies with ASA 1-3 showed no significant difference in outcome. CONCLUSION:Sedation bronchoscopy is a safe procedure. The staff administering sedation may react differently to periprocedural respiratory and cardiovascular events. Propofol application is not associated with a clinically relevant increase in complication rate. There is no evidence that ASA status is a predictor of individual risk at bronchoscopy.

OBJECTIVES:Preoperative risk prediction in thoracic surgery remains difficult for individual patients, as most risk assessment models do not include perioperative factors. We hypothesized that the perioperative kinetics of growth differentiation factor 15 (GDF-15) in patients' serum predicts the risk of postoperative pulmonary complications. DESIGN:A single-center prospective observational cohort study. SETTING:University hospital. PARTICIPANTS:One hundred one consecutive adult patients undergoing non-cardiac thoracic surgery. INTERVENTIONS:None. MEASUREMENTS:The primary endpoint, postoperative pulmonary complications (PPC), was a composite endpoint consisting of pneumonia, severe respiratory failure, reintubation, and Acute respiratory distress syndrome. Pre- and postoperative serum GDF-15 measurements were performed. MAIN RESULTS:During the median postoperative hospital stay of 8.7 days (median [IQR 6.6-10.4]), 23 patients with PPC were identified. Compared to the preoperative baseline, significantly higher mean concentrations of GDF-15 were observed in patients with PPC than in patients without PPC at the end of surgery (4371 [IQR 2560-6991] v 2776 [IQR 2004-3721] pg/mL, p = 0.003) and 72 hours after surgery (5040 [IQR 3482-6527] v 2810 [2178-3935] pg/mL, p < 0.001) with a significant association of the increase in GDF-15 and the hazard ratio for PPC. In a multivariate Cox proportional hazards model, an increase in GDF-15 levels >60% at the end of surgery (hazard ratio 5.9 (95% confidence interval 1.73-20.09) and an increase of >68% 72 hours after surgery (hazard ratio) 4.1 (95% confidence interval 1.36-12.62) was significantly associated with PPC after thoracic surgery. CONCLUSIONS:In patients undergoing thoracic surgery, perioperative assessment of GDF-15 serum kinetics helps to stratify the postoperative risk of PPC.

IntroductionBoth thoracic epidural analgesia and thoracic paravertebral analgesia are effective techniques to control pain and minimize the stress response following thoracic surgery. We hypothesized that continuous neuraxial techniques may be associated with a decrease in the incidence of postoperative mortality after thoracotomy. Additionally, we aimed to identify subgroup populations that may benefit more from neuraxial anesthesia.Method1620 patients who underwent open thoracotomy were included in this retrospective study from the German Thoracic Registry database at four university hospitals. All-cause inpatient mortality was determined for patients who had and did not have neuraxial anesthesia. Logistic regression was used to adjust for and explore various covariates.ResultsContinuous neuraxial analgesia was associated with a lower overall mortality in the postoperative period (2.9%, 23/796 vs 5.3%, 44/824, p=0.02) only after the univariate analysis but not the multivariable analysis (OR 0.49, 95 % CI 0.237 to 1.12, p=0.15). In patients with epidural or paravertebral catheters, mortality was significantly lower in the following subgroups: age >75 (5/113 vs 18/77, OR 0.1, 95% CI 0.02 to 0.67, p=0.02), American Society of Anesthesiologists Performance Score >III (11//97 vs 33/155, OR 0.32, 95% CI 0.11 to 0.89, p=0.03), chronic kidney disease (5/83 vs 16/77, OR 0.16, 95% CI 0.03 to 0.82, p=0.03), and postoperative sepsis (9/21 vs 17/25, OR 0.13, 95% CI 0.07 to 0.44, p<0.01).ConclusionsNeuraxial analgesic techniques are associated with reductions in postoperative mortality after open thoracic surgery in selected patients.

Background: Postoperative pulmonary complications (PPCs) are the most common complications following lung surgery and can lead to increased postoperative mortality. In this study, we examined the incidence of PPCs, the in-hospital mortality rate, and the risk factors associated with PPCs in patients undergoing open thoracotomy lung resection (OTLR) for reasons other than primary lung cancer. Methods: Data from this multicenter, retrospective study involving 1.368 patients were extracted from the German Thorax Registry and analyzed using univariate and multivariable statistical methods. Results: In total, 278 patients showed at least one PPC. The presence of PPCs was associated with a significantly higher in-hospital mortality rate (7.2% vs. 1.5%; p = 0.000). Multivariable stepwise logistic regression analysis showed absolute age (OR 1.02) and BMI ≤ 19 (OR 2.6) as independent patient-specific risk factors. Significant preoperative risk factors included re-thoracotomy (OR 4.0) and FEV1 < 60% (OR 2.5). Procedure-related independent risk factors for PPCs included a surgical duration surpassing 195 min (OR 2.7), the continuation of invasive ventilation post-surgery (OR 3.8), and an intraoperative infusion of crystalloids greater than 6 mL/kg/h (OR 1.8). Conclusions: Optimizing intraoperative fluid therapy and on-table extubation when possible may reduce the incidence of PPCs and associated mortality.

The increasing incidence of malignant lung diseases, neoadjuvant therapies, and the expected detection of operable stages through future lung cancer screening require differentiated preoperative decisions regarding functional operability against the background of an increase in respiratory diseases, especially COPD, but also interstitial lung diseases. Since the postoperative risk of cardiovascular and pulmonary complications after lung resection increases with the extent of lung parenchymal resection and the pre-existing impairment of organ function of the heart, lungs, kidneys, and metabolism, these also require special attention. Given the increasing number of elderly patients over 75 years of age, this also applies to frailty, which represents another key parameter in structured evaluation.

Background. The relevance of cold agglutinins in lung transplantation (LTx) recipients is unclear. While there is typically no intentionally induced hypothermia, the cold preservation of organs could potentially lead to microvascular injury and vascular occlusion after implantation and reperfusion in the presence of cold agglutinins. This study aims to analyze the impact of cold agglutinins in lung transplant recipients on short- and long-term outcomes after LTx. Methods. We retrospectively analyzed the medical records of 251 patients who underwent LTx at our institution between March 2003 and June 2023. One hundred seventy-three patients were included in the study. Statistical analysis was performed using SPSS and GraphPad software. Results. One hundred seventy-three of 251 (69%) of the lung transplant recipients were tested for cold agglutinins, which were positive in 78 of 173 (45%) patients. Most had a temperature amplitude of 4 °C; a broader temperature amplitude was detected in 9 of 78 (12%) patients. While there was no effect on overall long-term survival, cold agglutinins were associated with an increased incidence of reperfusion edema (P = 0.0002), severe primary graft dysfunction grade 2/3 (PGD2/3; P = 0.001), and early postoperative thromboembolism (P = 0.04). Multivariate analysis revealed PGD2/3 and thromboembolism as independent predictors of reduced long-term survival (P = 0.003 and P = 0.003, respectively). Plasmapheresis shortly before LTx in selected patients with a high cold agglutinin titer and broad temperature amplitude removed the cold agglutinins for at least 2 mo with good patient outcomes. Conclusions. Cold agglutinins are associated with an increased incidence of reperfusion edema, PGD2/3, and early postoperative thromboembolism after LTx. Further studies are warranted to evaluate the benefits of regular screening.

Objective Acute kidney injury (AKI) is a common and clinically significant complication following TAVR. Venous congestion is increasingly recognized as a key factor in perioperative organ dysfunction. The VExUS score offers a non-invasive method to quantify systemic venous congestion via ultrasound; however, its predictive value for AKI in the context of periinterventional cardiology remains unclear. This study aimed to evaluate the incidence of AKI after TAVR and its association with the VExUS score. Design and method This retrospective, single-center observational study included patients undergoing trans-femoral TAVR. The VExUS score was assessed using standardized echocardiography pre-procedure and six hours post-intervention, evaluating the inferior vena cava, hepatic, portal, and renal vein flow profiles. Acute kidney injury (AKI) was defined according to KDIGO criteria within days 1, 2 and 7 post-intervention or days of discharge (VARC-3). Predictive performance was evaluated using ROC analysis as well as uni- and multivariable logistic regression. Results and conclusions In this study of 101 patients undergoing transfemoral TAVR (mean age 83 years, 47% female), the incidence of AKI was 17.8% according to KDIGO criteria (stage I–III). Elevated VExUS score more than equal to 1 among preoperative and post-intervention patients were 73% and 53.5% respectively. The ROC analysis demonstrated an AUC of 0.62 for preoperative (95% CI: 0.49-0.75) and AUC of 0.97 (95% CI: 0.95– 1) for post TAVR patients indicating good discriminatory power. These findings demonstrate that higher VExUS scores are significantly associated with AKI after TAVR, highlighting venous congestion as a key contributing factor.Pre and Postoperative assessment of the VExUS score in TAVR patients offers a promising tool for early prediction of AKI and underscores the role of venous congestion in its pathophysiology. Present findings align with prior evidence reinforcing the relevance of systemic venous congestion. Future larger sample studies are needed to validate these results and explore the integration of the VExUS score into routine peri-interventional risk assessment.

The increasing incidence of malignant lung diseases, neoadjuvant therapies, and the expected detection of operable stages through future lung cancer screening require differentiated preoperative decisions regarding functional operability against the background of an increase in respiratory diseases, especially COPD, but also interstitial lung diseases.Since the postoperative risk of cardiovascular and pulmonary complications after lung resection increases with the extent of lung parenchymal resection and the pre-existing impairment of organ function of the heart, lungs, kidneys, and metabolism, these also require special attention. Given the increasing number of elderly patients over 75 years of age, this also applies to frailty, which represents another key parameter in structured evaluation.

Background Interest in passive flow filter systems to remove sevoflurane from anaesthetic machine exhaust have increased recently to mitigate the environmental impact of volatile anaesthetics. These filter systems consist of chemically activated carbon, with limited evidence on their performance characteristics. We hypothesised that their efficiency depends on filter material. Methods Binding capacity was tested for three carbon filter materials (CONTRAfluran®, FlurAbsorb®, and Anaesthetic Agent Filter AAF633). Adsorption efficiency and resistive pressure were determined during simulated ventilation at different stages of filter saturation and fresh gas flow. In addition, sevoflurane concentration in filtered gas was measured at randomly selected anaesthesia workstations. Results Sevoflurane concentration in filtered gas exceeded 10 ppm when saturated with 184 ml sevoflurane each for CONTRAfluran and FlurAbsorb and 276 ml for AAF633. During simulated ventilation, sevoflurane concentration >10 ppm passed through CONTRAfluran and AAF633 at fresh gas flow 10 L min−1 only at maximum saturation, but through FlurAbsorb at all stages of saturation. The resistance pressure of all filters was negligible during simulated ventilation, but increased up to 5.2 (0.2) cm H2O during simulated coughing. At two of seven anaesthesia workstations, sevoflurane concentration in filtered exhaust gas was >10 ppm. Conclusions Depending on the filter material and saturation, the likelihood of sevoflurane passing through passive flow carbon filters depends on the filter material and fresh gas flow. Combining the filter systems with anaesthetic gas scavenging systems could protect from pollution of ambient air with sevoflurane.

The Airway Management Guideline is supposed to serve as a tool for orientation and decision -making and as such it contributes to the optimal treatment of anesthaesiology and intensive medical care patients: A preanaesthesiological evaluation searches for anatomical and physiological indications for a difficult mask ventilation and intubation. This includes the evaluation of the patient's mouth opening, dental status, protrusion of the lower jaw, range of motion of the cervical spine and existing pathologies. Securing the aiways should proceed while spontaneous breathing is maintained, provided that predictors or anamnestical indications of a difficult or impossible mask ventilation and / or endotraheal intubaton exist. Various techniques may be applied to this end. In case of an unexpected difficult airway, using a videolaryngoscope will be recommended after an unsuccessful direct laryngoscopy. For this reason, a videolyarygoscope should be available at each and every anaesthesiological workplace. In case of patients who are at risk of aspiration or patients who are critically ill, the airways should be primarily secured with the aid of a videolaryoscope. Se- curing the airways by translaryngeal and transtracheal techniques is the last resort in airway management. The execution and / or supervision of securing airways at the ICU lies in the competence of the medical and nursing staff who are experienced in securing airways. Both a solid qualification and regular training courses are essential. Clear communica- tion and interactions among team mem- bers are obligatory prior to every single airway securement. Once an airway has been secured the correct position of the endotracheal tube must be ascertained by means of capnography.

The German guidelines for airway management aim to optimize the care of patients undergoing anesthesia or intensive care. The preanesthesia evaluation is an important component for detection of anatomical and physiological indications for difficult mask ventilation and intubation. If predictors for a difficult or impossible mask ventilation and/or endotracheal intubation are present the airway should be secured while maintaining spontaneous breathing. In an unexpectedly difficult intubation, attempts to secure the airway should be limited to two with each method used. A video laryngoscope is recommended after an unsuccessful direct laryngoscopy. Therefore, a video laryngoscope should be available at every anesthesiology workspace throughout the hospital. Securing the airway should primarily be performed with a video laryngoscope in critically ill patients and patients at risk of pulmonary aspiration. Experienced personnel should perform or supervise airway management in the intensive care unit.

Die Leitlinie Atemwegsmanagement soll zur optimalen Versorgung der anästhesiologisch und intensivmedizinisch betreuten Patient:innen beitragen. Die präanästhesiologische Evaluation ist ein wichtiger Baustein zur Detektion anatomischer und physiologischer Hinweise für eine erschwerte Maskenbeatmung und Intubation. Wenn Prädiktoren für eine schwierige oder unmögliche Maskenbeatmung und/oder endotracheale Intubation vorliegen, soll die Atemwegssicherung unter Erhalt der Spontanatmung erfolgen. Besteht ein unerwartet schwieriger Atemweg, wird nach erfolgloser direkter Laryngoskopie die Verwendung eines Videolaryngoskops empfohlen, weshalb ein Videolaryngoskop an jedem anästhesiologischen Arbeitsplatz verfügbar sein soll. Bei aspirationsgefährdeten und kritisch kranken Patient:innen soll primär die Sicherung der Atemwege mit einem Videolaryngoskop erfolgen. Die Durchführung bzw. Supervision von Atemwegssicherungen auf der Intensivstation obliegt im Atemwegsmanagement erfahrenem Personal.