Airway Assessment

Introduction

Every patient coming for anesthesia requires an airway assessment. The goal of the airway assessment is to determine the ease of bag-mask ventilation (BMV), tracheal intubation, LMA placement and emergency front of neck access (FONA). FONA is beyond the scope of this review card but is available in the listed references.

Airway Evaluation 1

Overview

  1. History of difficult intubation
  2. Mouth opening
  3. Mallampati score
  4. Thyromental distance
  5. Mandibular protrusion
  6. Neck circumference
  7. Neck range of motion
  8. Status of dentition
  9. NPO status

As seen below, the elements of the airway exam can raise suspicion for difficulty with airway manipulation

Mallampati Score 2

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Predictors of Difficult Bag Mask Ventilation 3

Santa Claus

  1. Beard & facial hair
  2. Obesity (BMI >35)
  3. Neck circumference (>44cm)
  4. Edentureless
  5. Sleep apnea

Predictors of Difficult Direct Laryngoscopy 3

The bolded items are predictors of difficult direct & video laryngoscopy

  1. Mallampati 3&4
  2. Thyromental distance < 6cm
  3. Limited C-spine extension
  4. Limited mouth opening
  5. OSA or thick neck
  6. Increased BMI (conflicting results)
  7. Previous neck radiation
  8. Limited mandibular protrusion
  9. Male sex

Predictors of Difficult Video Laryngoscopy 3

  1. History of difficult direct laryngoscopy
  2. Thyromental distance < 6cm
  3. Limited C-spine extension
  4. Limited mouth opening
  5. Soiled airway
  6. Limited mandibular protrusion
  7. Male sex

Predictors of Difficult LMA placement

  1. No teeth
  2. Mallampati 3&4

  1. J.F. Butterworth, D.C. Mackey, J.D. Wasnick, Morgan and mikhail's clinical anesthesiology, 6th edition, 2018 Private or Broken Links
    The page you're looking for is either not available or private!
     ↩

  2. Birdi T, Sullivan P. Ottawa Anesthesia Primer. Toronto, Ontario: Echo Book Publishing; 2012. ↩

  3. J. Adam Law, Laura V. Duggan, Mathieu Asselin, Paul Baker, Edward Crosby, Andrew Downey, Orlando R. Hung, George Kovacs, François Lemay, Rudiger Noppens, Matteo Parotto, Roanne Preston, Nick Sowers, Kathryn Sparrow, Timothy P. Turkstra, David T. Wong, Philip M. Jones, undefined undefined, Canadian Airway Focus Group updated consensus-based recommendations for management of the difficult airway: part 2. Planning and implementing safe management of the patient with an anticipated difficult airway, 2021 Private or Broken Links
    The page you're looking for is either not available or private!
     ↩ ↩2 ↩3