All India Difficult Airway Association 2025 guidelines for the management of unanticipated difficult airway in adults, obstetrics, and paediatrics and the management of at-risk extubations: Guideline development process and methodology

The All India Difficult Airway Association (AIDAA) methodology document describes the guideline development process and methodology employed for the AIDAA 2025 Guidelines for the management of unanticipated difficult airway in adults, obstetrics, and paediatrics and the management of <i>at-risk</i> extubations. The process for constituting the Steering Committee and Guideline Subcommittees and managing conflicts is described. Patients or Population-Intervention-Comparison-Outcome (PICO) questions were formulated for the respective guidelines. A systematic literature search was performed by a librarian from January 2000 to December 2024. A PRISMA flowchart describing the search process was prepared for each research question. The evidence was summarised and recommendations categorised according to the American Heart Association (AHA) Class of Recommendations and Level of Evidence for clinical strategies, interventions, treatments, or diagnostic testing in patient care. In addition, a Delphi process was conducted by the Steering Committee and a Delphi methodologist to achieve consensus among 24 airway experts for the clinical research questions using Delphi methodology, where the evidence was either lacking or weak. The Steering Committee coordinated the iterative Delphi rounds and refrained from participating in the voting process to prevent potential bias. The Delphi survey results were reported based on the Accurate Consensus Reporting Document (ACCORD) Guidelines<i>.</i> Consensus was established when 75% or more of panellists selected the same option(s) in multiple-choice statements and the seven-point Likert scale statements. Expert consensus statements were drafted from the survey statements that achieved consensus. A plan for guideline dissemination, promotion, integration into clinical practice and revision has also been included.