Module 2a: airway assessment

Question 1

What four key scenarios is the airway being assessed for?

Answer 1

Difficulty with BVM

Difficulty with intubation

Difficult rescue of the airway with supraglottic airway

Difficulty with front of neck access

Question 1

What are important factors to get in history for possible clues around airway problems?

Answer 1

previous anaesthetic hx

previous anaesthetic records (difficulty with bvm/intubation)

hx of congenital, acquired or traumatic pathology affecting airway

Previous neck or head surgery

Previous radiotherapy to airway/neck area

Question 2

What are the 2 approaches to examining the airway?

Answer 2

Systematic approach:
Face, mouth, teeth, neck and range of motion, trachea

4 D’s: disproportion, distortion, dysmobility and dentition

Question 3

What must you check for in the systematic approach when looking at the face?

Answer 3

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

Question 4

What must you look for in systematic approach when assessing the mouth?

Answer 4

 Assess the MOUTH OPENING
 Look for macroglossia
 Look for tumours, trauma, other masses
 The MALLAMPATI SCORE is a predictor of difficult intubation
 Dentition

Question 5

What must be assessed when looking at the neck in the systematic approach?

Answer 5

1ST: exclude C-SPINE injury

Then:
- Assess length and thickness of neck
- Range of movement: extension and flexion
- Thyromental + sternomental distances
- Check if trachea is central

Question 6

In 4 D’s approach what must be looked for in disproportion?

Answer 6

 Macroglossia (big tongue)
 Micrognathia (small chin)
 High-arched palate
 Bony abnormalities
 Short thick neck

Question 7

What must be check for in distortion in 4 D’s assessment?

Answer 7

 Airway trauma
 Epiglottitis
 Laryngeal tumours

Question 8

What must be checked at dysmobility in 4 D’s

Answer 8

 Limited mouth opening
 Fixed cervical spine / decreased extension
 Cervical spine injury: NEVER examine neck movement if a C-spine injury has not been excluded

Question 9

What must be checked for under dentition in 4D’s assessment?

Answer 9

Endentulous (no teeth)
missing teeth
prominent teeth
loose teeth
dental work

Question 10

What bedside tests can be done to predict difficulty of intubation?

Answer 10

Distances: thyromental, intercisor, thyrohyoid

Mallampati classification

Neck mobility

Question 11

What is Mallampati class 1

Answer 11

complete visualization of soft palate

Question 12

What is Mallampati class 2

Answer 12

complete visualization of uvula

Question 13

What is Mallampati class 3

Answer 13

Visualization of only base of uvula

Question 14

What is Mallampati class 4

Answer 14

No soft palat visible