Figure 42-23 Single-flow diagram version of the American Society of Anesthesiologists (ASA) Difficult Airway Algorithm. +, Always consider calling for help (e.g., technical, medical, surgical) when difficulty with mask ventilation or tracheal intubation is encountered; ++, consider the need to preserve spontaneous ventilation; *, nonsurgical tracheal intubation choices consist of laryngoscopy with a rigid laryngoscope blade (many types), blind orotracheal or nasotracheal intubation, fiberoptic or stylet technique, retrograde technique, illuminating stylet, rigid bronchoscope, and percutaneous dilational tracheal entry. Benumof^[30] offers a complete discussion of these tracheal intubation choices. (Adapted from Benumof JL: Laryngeal mask airway and the ASA difficult airway algorithm. Anesthesiology 84:686, 1996.)