Airway Assessment

Question 1

N.B. About Airway Assessment

Answer 1

Patient’s airway MUST ALWAYS BE EXAMINED.

Airway must be Maintained, Protected and Secured

Question 2

Predicting a difficult airway

Answer 2

Assessed whether there might be potential difficulty in four key scenarios
Difficulty with bag-mask ventilation
Difficulty with intubation
Difficult rescue of the airway with a supraglottic airway if the above fail
Difficulty with front-of-neck access (FONA) if all three of the above fail
Some factors affect both BMV and intubation (e.g. obesity), others primarily BMV (e.g. a large beard), others primarily intubation (e.g. abnormal dentition)

Question 3

Hx specific for AIRWAY ASSESSMENT

Answer 3

Previous anaesthetic history (check records) including airway management.
History of congenital, acquired/traumatic pathology affecting airway.
Previous head or neck surgery.
Previous radiotherapy to airway / head area.

Question 4

Systematic Approach to Clinical Airway Examination

Answer 4

1) Face
2) Mouth
3) Dentition/teeth
4) Neck and its range of movement
5) Trachea

Question 5

Airway Assessment: FACE

Answer 5

Overt tumours
Congenital syndromes (Trisomy 21, Pierre-Robin Sequence)
Facial trauma
Facial hair

Question 6

Airway Assessment: MOUTH

Answer 6

Assess the MOUTH OPENING (3 fingers of patient or >5)
Look for macroglossia
Look for tumours, trauma, other masses
The MALLAMPATI SCORE is a predictor of difficult intubation

Question 7

Airway Assessment: DENTITION

Answer 7

Can make laryngoscopy and intubation difficult due to:

• NO TEETH
• MISSING TEETH
• PROMINENT TEETH
• LOOSE TEETH
• DENTAL WORK

Question 8

Airway Assessment: NECK

Answer 8

1) Fist EXCLUDE C-SPINE INJURY (if suspected, appropriate precaution)
2) Assess the LENGTH (N±8cm) and THICKNESS (N±33cm) of the neck
3) RANGE OF MOVEMENT:
Extension and flexion (A and P positioning (mandible-occipital)
The THYROMENTAL (N±6.5cm) and STERNOMENTAL (N±12.5cm) (distances, if reduced, are predictors of difficult intubation)
4) Check whether the TRACHEA is central

Question 9

Factors for Difficulty of Bag Mask Ventilation (BONES)

ALWAYS POSITION THE PATIENT PROPERLY (neck flexion and head extension)
Ear and sternal notch at same plane

Answer 9

Beard 
Obesity
No teeth
Elderly
Snoring (Sleep Apnoea)/Stiff lungs
REMEMBER TECHNIQUES
Head tilt chin lift
Jaw Thrust
Vice Grip

Question 10

Factors for Difficulty Intubation LEMONS

Answer 10

Look externally THINK D's
Evaluate 3-3-2 rule and distances
Mallampati Score of >/=3
Obstruction (infection masses)
Neck Mobility (A-O)
Spine (C) Stiff neck

Question 11

Factors for Difficulty Intubation

4 “D”s

Answer 11

1) DISPROPORTION
Macroglossia (big tongue)
Micrognathia (small chin)
High-arched palate
Bony abnormalities
Short thick neck
2) DISTORTION
Airway trauma
Epiglottitis
Laryngeal tumours
3) DYSMOBILITY
Limited mouth opening
Fixed cervical spine / decreased extension
Cervical spine injury
4) DENTITION
NO TEETH
MISSING TEETH
PROMINENT TEETH
LOOSE TEETH
DENTAL WORK

Question 12

Mallampati Classification

Answer 12

Class I: Complete visualisation of soft palate
Class II: Complete visualisation of the uvula
Class III: Visualisation of the base of the uvula
Class IV: Soft palate is not visible (ALSO CAN’TS LMA)

Question 13

Factors for Difficulty SGA (LMAs)

RODS

Answer 13

Restrictive mouth
Obstructive
Distortion/Disruption (infection)
Stiff lungs (C-spine)

Question 14

Factors for Difficulty Surgery (SHORTY)

Answer 14

Surgery/Scar
Haematoma
Obesity
Radiotherapy
Tumour/Trauma
Young

Question 15

Factors for Difficulty due to physiological problems (AHH)

Answer 15

Acidosis
Hypoxia
Hypertension