Airway Assessment

A structured approach to airway assessment has been advocated by Greenland based on
the proposed “model for direct laryngoscopy and tracheal intubation” 12,13 . Each phase of
direct laryngoscopy has implications for airway assessment. The static phase requires the
assessment of ideal positioning the head and neck to optimise laryngoscopy and intubating
conditions, as well as supraglottic airway placement, bag-mask ventilation and during patient
sedation. Dynamic phase assessment is developed from the laryngoscopy and intubation
process. It consists of an evaluation of a number of movements including mouth opening,
anterior displacement of the mandible and anterolateral compression/displacement of the
submandibular tissues in relation to the maxilla. With reference to each phase, airway
assessment is undertaken to evaluate three stylised columns – anterior, middle and posterior –
using traditional airway assessment techniques (Figure 7) 12,13 .
Figure 7. The three columns – anterior column (blue triangle), middle column (green line)
and posterior column (red line).
Reorganising our established airway assessment tests into this compartmentalised evaluation
of the static and dynamic phases of direct laryngoscopy allows the operator to answer two
important questions:
1. Can laryngoscopy and intubating conditions be further optimised prior to the procedure?
2. Are there any anticipated “difficulties” associated with the manoeuvres required to visualise
the glottis and intubate the trachea?
Interpretation of the airway assessment findings permits the generation of an airway plan
devised to combat the potential problems identified. This process involves a simultaneous
evaluation of the three columns and reflection on the two airway curves.
42 Airway Assessment