Anaesthetists Handbook - MEDICAL EDUCATION at University ...

Airway assessmentManaging difficult airwaysA detailed preoperative airway assessment can assist you inpredicting difficult intubation. Effective airway management requirescareful planning. You should have a back up plan for when theprimary plan fails.HistoryDuring the preoperative visit, you should elicit previous ‘difficultairway alerts’, surgeries or injuries in head and neck, radiotherapy,snoring, obstructive sleep apnoea, neurological disorders.Clinical examination:Any gross craniofacial anomaly and gross abnormality of neck shouldbe apparent on clinical examination• Mouth opening: when fully opened should allow patient’s middlethree fingers held in vertical plane.• Jaw movement: Good forward movement (lower teeth canprotrude further than the upper teeth) is associated with easylaryngoscopy.• Buck teeth are associated with high score on Mallampaticlassification and also limit the protrusion of lower teeth furtherthan upper teeth.• Movement of cervical spine and extension at atlanto-occipitaljoint.• Thyromental distance should be > 6.5 cm (measured while neckis extended).• Sternomental distance should be > 12.5 cm (measured whileneck is extended).Anaesthetists Handbook January 2010 17