Airway Management in Anesthesia: Progress, Precision, and the Path Forward

Dear Colleagues,

Airway management remains a cornerstone of anesthetic practice and a crucial element in ensuring patient safety. The ability to establish and maintain a patent airway is not merely a technical skill—it is a vital competency that can mean the difference between life and death. Over the past two decades, remarkable advances have transformed the landscape of airway management, driven by innovations in equipment, imaging, training modalities, and an understanding of human factors.

Despite these developments, airway-related complications remain among the leading causes of anesthesia-related morbidity and mortality. The increasing complexity of patient populations—including the morbidly obese, frail elderly, critically ill, and those with anatomical variations—demands more than routine expertise. It requires an adaptive, evidence-informed, and patient-centered approach that integrates technology with clinical judgment.

Innovations such as videolaryngoscopy [1], videolaryngeal mask airways (VLMAs) [2], and real-time ultrasonography have significantly enhanced airway visualization and success rates. In particular, the videolaryngeal mask airway combines the advantages of supraglottic ventilation with direct visual guidance, improving placement accuracy and rescue options in difficult airway scenarios. Moreover, combination techniques—such as the simultaneous use of videolaryngoscopy and an optical scope—offer complementary views and facilitate intubation in anatomically challenging or previously failed airways [3,4]. These multimodal strategies exemplify the shift from reliance on a single device to integrated, stepwise algorithms rooted in anticipation and preparedness.

This special edition brings together leading voices in the field to highlight current best practices, emerging innovations, and persistent challenges in airway management. Our vision is to foster a culture where airway safety is never compromised, where every clinician is empowered through education and rehearsal, and where airway management evolves through collaboration, research, and reflection. As we chart the future of anesthesia, let us place airway excellence at its core, ensuring that every breath, in every patient, is safeguarded by design.

Please have a look at several alternative titles designed to evoke innovation, urgency, and leadership in airway management for a special journal edition:

1. “Airway Management in Anesthesia: Elevating Safety, Skill, and Science”;
2. “Redefining the Airway: Innovation, Integration, and Impact in Anesthesia”;
3. “Mastering the Airway: From Vision to Precision in Modern Anesthesia”;
4. “Securing the Lifeline: New Frontiers in Airway Management”;
5. “Airway Excellence: Bridging Technology, Technique, and Teamwork”;
6. “The Intelligent Airway: Advancing Practice Through Evidence and Innovation”;
7. “From Complexity to Clarity: A New Era in Airway Management”;
8. “Breathing New Life into Airway Management: Tools, Teams, and Tactics”;
9. “Beyond the Vocal Cords: Transforming Airway Management in the 21st Century”;
10. “The Future is Visual: Innovations and Strategies in Airway Management”.

References

1. Gómez-Ríos, M.Á.; Van Zundert, A.A.; McNarry, A.F.; Law, J.A.; Higgs, A.; De Jong, A.; Jaber, S.; Karamchandani, K.; Hansel, J.; Saracoglu, K.T.; et al. Guidelines on strategies for the universal implementation of videolaryngoscopy. Eur. J. Anaesthesiol. 2025, 42, 1­17. https://doi.org/10.1097/eja.0000000000002210.
2. Van Zundert, A.A.J.; Gatt, S.P.; Van Zundert, T.C.R.V.; Hagberg, C.A.; Pandit, J.J. Supraglottic Airway Devices: Present State and Outlook for 2050. Anesthesia Analg. 2024, 138, 337–349, https://doi.org/10.1213/ane.0000000000006673.
3. Van Zundert, A.A.J.; Pieters, B.M.A. Combined technique using videolaryngoscopy and Bonfils for a difficult airway intubation. Br. J. Anaesth. 2012, 108, 327–328, https://doi.org/10.1093/bja/aer471.
4. Pieters, B.M.; Theunissen, M.; van Zundert, A.A. Macintosh Blade Videolaryngoscopy Combined With Rigid Bonfils Intubation Endoscope Offers a Suitable Alternative for Patients With Difficult Airways. Anesthesia Analg. 2018, 126, 988–994, https://doi.org/10.1213/ane.0000000000002739.

Prof. Dr. Andre van Zundert
Dr. Manuel Ángel Gómez-Ríos
Guest Editors

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• airway management
• airway-related complications
• videolaryngoscopy
• videolaryngeal mask airways
• airway visualisation
• intubation
• critical care