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Year : 2021  |  Volume : 4  |  Issue : 3  |  Page : 145-147

My journey with the All India Difficult Airway Association

Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India

Date of Submission24-Nov-2021
Date of Acceptance24-Nov-2021
Date of Web Publication08-Dec-2021

Correspondence Address:
Prof. Sheila Nainan Myatra
Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Dr. Ernest Borges Road, Parel, Mumbai, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/arwy.arwy_63_21

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How to cite this article:
Myatra SN. My journey with the All India Difficult Airway Association. Airway 2021;4:145-7

How to cite this URL:
Myatra SN. My journey with the All India Difficult Airway Association. Airway [serial online] 2021 [cited 2022 Jun 29];4:145-7. Available from: https://www.arwy.org/text.asp?2021/4/3/145/331907

'Life is a journey not a destination'

-Ralph Waldo Emerson

The words of the famous poet Waldo echo in my head as I remember my journey with the All India Difficult Airway Association (AIDAA).

Airway management is a vital skill that is relevant to the practice of almost all medical specialities and clinicians, especially anaesthesiology, intensive care, emergency medicine, paediatrics and head-and-neck surgeons to name a few. In the last few decades, there has been a paradigm shift in our approach to airway management techniques, with a wide variety of tools and gadgets available to facilitate our practice. As one would expect in a country as large as India, there is wide variation in airway management practices. A need to standardise and improve our knowledge and skills in airway management using an evidence-based approach while maintaining patient safety is much required. To satisfy this long-felt need, a group of anaesthesiologists with a special interest in airway management launched the AIDAA in Mangalore in 2010. The society is dedicated to imparting knowledge and skills in airway management to promote safe airway practices. I am very proud to be one of the founder members of this organisation. When I joined AIDAA, little did I know that I would one day lead this organisation.

In 2013 when the Mangalore group handed over the baton to Mumbai, we happily accepted the responsibility from our friends, honoured by their trust in us to take the society to greater heights. Professor JV Divatia and I were appointed as the President and General Secretary, respectively of the AIDAA. The challenges ahead were huge with many unanswered questions. In a country as vast as India, while it would be easier to reach out to few select centres of excellence that had the available technological advances for airway management, our objective was to reach out to airway operators in the smallest of district-level hospitals to improve airway management practices and enhance patient safety. How could we achieve these goals while operating from a metro city like Mumbai? At that point, the organisation had <100 members among who were several well-meaning individuals who were committed to the mission of AIDAA and were happy to help. We capitalised on the enthusiasm and commitment of these airway experts to form an Executive Committee (EC) for AIDAA, acknowledging that a team, rather than two individuals would be better placed to take AIDAA forward.

True to the African proverb − If you want to go fast, go alone. If you want to go far, go together- the formation of the AIDAA-EC with members from across the country brought in the much-needed diversity, novel ideas and promotion of AIDAA across the nation. The AIDAA-EC worked together as a family to promote the mission of the society. Very soon, a Constitution was drafted for AIDAA which was approved by the members in the annual general body meeting. This helped streamline the functioning of the society and have a truly democratic process in place. Various branches of AIDAA were formed across the country. By getting airway interest groups onto a common platform, AIDAA made it possible to share ideas and promote teaching and training in airway management across the country through focused workshops and meetings. These efforts at disseminating knowledge and skills were further enhanced by the AIDAA National Airway Conferences, which grew from a small meeting of <50 members to the mega event that it is today, with participation from expert national and international faculty and delegates, making it a high-quality world-class event.

It has been common practice in India to follow guidelines for difficult airway management from international societies such as the American Society of Anesthesiologists and the Difficult Airway Society.[1],[2] A vast country such as India, with thousands of airway practitioners handling complex cases with challenging airways to manage, did not have its own airway management guidelines to match its needs and situation. There was a long-felt need to develop Indian guidelines for the management of the unanticipated difficult airway to enhance patient safety.[3],[4] In addition, it was noticed that there were no available guidelines for the management of tracheal intubation in critically ill patients who have a physiologically difficult airway, increasing the risk of complications during airway management.[5] Rather than have a general airway guideline and come up with airway guidelines for other specialities in the subsequent years, the AIDAA took up the mammoth task of developing five guidelines for difficult airway management by creating individual working groups to work at the same time to meet this goal. A robust process was followed to develop the guidelines, which included an exhaustive review of literature along with a review of the existing difficult airway guidelines. A survey was conducted to help make recommendations in areas where the evidence was weak. In addition, inputs were taken from various national and international experts. The tremendous brainstorming, discussion and debate that occurred during the process only helped make sound guidelines. The five guidelines were simultaneously published in the December 2016 issue of the Indian Journal of Anaesthesia. This included unanticipated difficult tracheal intubation in the adult, obstetric and paediatric patients, guidelines for tracheal intubation in ICU and guidelines for the management of difficult extubation.[5],[6],[7],[8],[9]

The simultaneous publication of these five guidelines by AIDAA gave the society global recognition and visibility. Various authors and societies cited the AIDAA guidelines. In addition, the AIDAA guidelines were considered during the development of various international guidelines, including the PUMA Project.[10] The AIDAA guidelines provide clinicians a comprehensive structured approach for decision-making when encountered with a difficult airway in most of the clinical situations encountered in daily practice, irrespective of the level of experience or the resources availability. Some of the unique features of the guidelines are the emphasis on peri-intubation oxygenation, the use of oxygen saturation threshold of ≥95% to restrict the number of attempts at tracheal intubation or insertion of a supraglottic airway device (SAD) and choice of the technique of cricothyroidotomy based on the familiarity and the availability of equipment. In addition, a new term 'complete ventilation failure' was introduced to describe the crisis situation where ventilation using a tracheal tube, face mask and SAD has failed, despite providing the best effort. This critical language is not only clear, concise, precise, specific, highlighting a sense of emergency but also defines the appropriate trigger for an emergency cricothyroidotomy.[11] The publication of these guidelines has undoubtedly been one of the greatest achievements of AIDAA. While we hope that these guidelines help clinicians manage an unanticipated difficult airway, several questions remain unanswered. How many people follow the AIDAA guidelines in India? Has their implementation translated into improved patient care and safety?

The next big venture of AIDAA was to have its own journal, a platform for airway experts across the globe to share their expertise and research. There was no journal dedicated to airway management issues at that time. This official publication of the AIDAA released in 2018 was aptly titled 'Airway'. The journal has published four volumes with over 150 articles in the last four years. The last few years have seen an explosion in new thought, knowledge, technology and training methodology in airway management. AIDAA has made great progress over the past 12 years and taken tremendous efforts in disseminating knowledge and skills in airway management. The small society started in Mangalore now boasts of ten branches with over 1000 members. While we have made significant achievements, there is still a long way to go. Updating and publishing the AIDAA guidelines, indexing and promotion of our journal and conducting structured teaching, training and research activities are but a few of our future goals.

I have been truly fortunate and blessed to serve the society as General Secretary and President for two terms. It was a great honour for me to be conferred the AIDAA Nitte Oration in 2018. Together, we have grown as a family, learning, sharing and imparting our knowledge and skill to improve airway management practices. As I hand over the baton to the next team, there is a sense of fulfillment and great joy at what we have achieved together, with hopes and dreams for the best that I believe is yet to come. AIDAA is not just an airway society, but a concept that should be taken forward with passion and dedication.

My journey with AIDAA has been truly enriching. Come join our mission. It will be a journey well worth the while!

  References Top

Apfelbaum JL, Hagberg CA, Caplan RA, Blitt CD, Connis RT, Nickinovich DG, et al. Practice guidelines for management of the difficult airway: An updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology 2013;118:251-70.  Back to cited text no. 1
Frerk C, Mitchell VS, McNarry AF, Mendonca C, Bhagrath R, Patel A, et al. Difficult airway society 2015 guidelines for management of unanticipated difficult intubation in adults. Br J Anaesth 2015;115:827-48.  Back to cited text no. 2
Ramkumar V, Divatia JV. Airway management guidelines: A safe passage to India. Indian J Anaesth 2016;60:883-4.  Back to cited text no. 3
[PUBMED]  [Full text]  
Myatra SN, Ramkumar V. Creating the Indian airway guidelines and beyond. Airway 2018;1:1-3.  Back to cited text no. 4
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Myatra SN, Shah A, Kundra P, Patwa A, Ramkumar V, Divatia JV, et al. All India Difficult Airway Association 2016 guidelines for the management of unanticipated difficult tracheal intubation in adults. Indian J Anaesth 2016;60:885-98.  Back to cited text no. 5
[PUBMED]  [Full text]  
Ramkumar V, Dinesh E, Shetty SR, Shah A, Kundra P, Das S, et al. All India Difficult Airway Association 2016 guidelines for the management of unanticipated difficult tracheal intubation in obstetrics. Indian J Anaesth 2016;60:899-905.  Back to cited text no. 6
[PUBMED]  [Full text]  
Pawar DK, Doctor JR, Raveendra US, Ramesh S, Shetty SR, Divatia JV, et al. All India Difficult Airway Association 2016 guidelines for the management of unanticipated difficult tracheal intubation in paediatrics. Indian J Anaesth 2016;60:906-14.  Back to cited text no. 7
[PUBMED]  [Full text]  
Myatra SN, Ahmed SM, Kundra P, Garg R, Ramkumar V, Patwa A, et al. All India Difficult Airway Association 2016 guidelines for tracheal intubation in the Intensive Care Unit. Indian J Anaesth 2016;60:922-30.  Back to cited text no. 8
[PUBMED]  [Full text]  
Kundra P, Garg R, Patwa A, Ahmed SM, Ramkumar V, Shah A, et al. All India Difficult Airway Association 2016 guidelines for the management of anticipated difficult extubation. Indian J Anaesth 2016;60:915-21.  Back to cited text no. 9
[PUBMED]  [Full text]  
Chrimes N, Higgs A, Law JA, Baker PA, Cooper RM, Greif R, et al. Project for universal management of airways Part 1: Concept and methods. Anaesthesia 2020;75:1671-82.  Back to cited text no. 10
Myatra SN, Patwa A, Divatia JV. Critical language during an airway emergency: Time to rethink terminology? Indian J Anaesth 2020;64:275-9.  Back to cited text no. 11
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