Understanding Anesthesiology - The Global Regional Anesthesia ...

Airway Assessment
The anesthesiologist must always perform a thorough preoperative
airway assessment, regardless of the planned anesthetic
technique. The purpose of the assessment is to identify potential
difficulties with airway management and to determine the most appropriate
approach. The airway is assessed by history, physical examination
and occasionally, laboratory exams.
Figure 3 Axis alignment using the “sniffing position”
On history, one attempts to determine the presence of pathology
that may affect the airway. Examples include arthritis, infection, tumors,
trauma, morbid obesity, burns, congenital anomalies and previous
head and neck surgery. As well, the anesthesiologist asks
about symptoms suggestive of an airway disorder: dyspnea,
hoarseness, stridor, sleep apnea. Finally, it is important to elicit a
history of previous difficult intubation by reviewing previous anesthetic
history and records.
The physical exam is focused towards the identification of anatomical
features which may predict airway management difficulties. It
is crucial to assess the ease of intubation. Traditional teaching maintains
that exposure of the vocal cords and glottic opening by direct
laryngoscopy requires the alignment of the oral, pharyngeal and
laryngeal axes (Figure 3). The “sniffing position” optimizes the
alignment of these axes and optimizes the anesthesiologist’s
chance of achieving a laryngeal view.
An easy intubation can be anticipated if the patient is able to open
his mouth widely, flex the lower cervical spine, extend the head at
the atlanto-occipital joint and if the patient has enough anatomical
space to allow a clear view. Each of these components should be assessed
in every patient undergoing anesthesia:
Original artwork by Linda Onorato. Digital mastery by Robert Barborini.
Used with permission of Linda Onorato.
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