Airway leadership - Message from the Chair

As many of the Airway Management Special Interest Group (SIG) members are either airway leads in their anaesthetic departments or advisory to those who have this task, it is timely to discuss how to pilot the airway management ship at a local level.

The Airway Management SIG is a significant contributor, along with other overseas groups, to significant and world-class peer-reviewed literature, education and research. This contribution is underpinned by provision of difficult airway management at a local departmental and regional level.

Despite the enormous advances in airway management including supraglottic airways, videolaryngoscopy, front of neck access and high flow nasal oxygenation, the education of technical and non-technical skills rests on the shoulders of airway management teachers throughout Australia and New Zealand. Although there are “rock stars” amongst the difficult airway élite, the true heroes are the teachers of airway management at the coal face. These are the unsung airway management heroes who have taught, discussed and provided guidance to juniors from when the first anaesthetic began.

Airway management remains the most hotly debated and at times the most decisive part of anaesthetic management. In other fields of anaesthesia, a lecturer may speak to a large audience most of which are unlikely to contest his or her views. In contrast, airway management lecturers speak to an auditorium of “experts” all looking to contest the lecturer based on their “n=1 experience”. Question and answer time following lectures can become “my opinion shaped in a form of a question (but not really)”.

Airway management leaders at a local area are often challenged and criticised for views that may not reflect the latest publications. However, their input into education and provision of patient safe environment is paramount. Airway management training and life-long education remains a critical area for patient safety as it always has been, and will continue to be, the “A” of “A, B, C”.

What is leadership? This means different things to different people and different situations. To me, the airway management leader guides education, research and clinical management for one goal: Improved patient safety. To that end, they need to wear two hats. One hat is that of a leader who drives airway management to support cutting edge development; thinking outside the box; and the ability to consider and develop new airway management concepts. The other hat is that of a leader of a local group of operators who look for guidance and help when encountering airway challenges. The latter is where the airway management expert shows this or her true value; to seek out and guide those who struggle with airway management. The critical expertise is not in the lecture halls but in the corridors of our institutions, when a junior and the local expert discuss a challenging airway case.

One of my pivotal memories as an anaesthetic trainee was when I failed to intubate an infant for elective hernia repair. I used a straight blade but was unable to view the glottis. My supervising consultant successfully performed the laryngoscopy and intubation but I was left deeply concerned about my failure. The next day, a senior paediatric anaesthetist asked me to explain in a step-wise manner how I performed the laryngoscopy. He then corrected a major deficit in my understanding of how the straight blade laryngoscopy is performed (i.e. by lifting the epiglottis rather than placing the tip in the vallecula). All my teachers had assumed I knew this fact and I think I must have skipped it in the text books, probably because I considered I knew all there was to know of the fundamentals. This episode gave me many lessons. Amongst them were the importance of 1) a methodical approach to teaching a skill, 2) never assuming you know the fundamentals, and 3) being a good, kind and benevolent teacher.

My advice: be a good teacher, be a kind boss, don’t beat your own drum and above all else make sure that patient safety is what drives you and not the accolades of your peers. What you teach will have a direct impact on patient safety and outcomes.

Professor Keith Greenland
Airway Management SIG Chair

Professor Keith Greenland, the chair of the Airway Management Special Interest Group, has been appointed Faculty Professor of Anaesthesia and Airway Management by the Difficult Airway Society (DAS), UK. The appointment is an award conferred in recognition of a member of the society’s national or international standing in the field of airway management “as established by outstanding contributions through publications, creative work or other appropriate forms of scholarship, and through teaching and administration.” 


Please see below links to the Airway Management SIG newsletter

Airway Incident in Anaesthesia Audit

Airway inventors

Regions Report

Research and publications



Airway Library Guides