3.7
Airway Evaluation
- There is not a single factor in airway assessment that can predict difficult airway
- Anticipated difficult airway covered in section IX
- Difficult airway covered on page 258
Previous Airway/Intubations History
- Airway type
- Attempts
- Blade size
- Laryngeal view classification (Figure 3.14)
- Final airway size
Presence/Suspicion of Obstructive Sleep Apnea (OSA) (Figure 3.15)
- OSA clinical management covered on pages 315–317
- Pediatric OSA covered on page 233
- Apnea Hypopnea Index (AHI)
- The AHI is the average number of apneic or hypopneic events lasting a minimum of 10 seconds per hour of sleep recorded during polysomnography
- Severity of OSA is dependent on their AHI
| Severity | Apnea hypopnea events (per hour) |
|---|---|
| Normal | <5 |
| Mild OSA | 5–15 |
| Moderate OSA | 15–30 |
| Severe OSA | >30 |
Figure 3.15 Adapted from Nagappa et al. [14]
Clinical Airway Evaluation
- Radiographically
- Performed only under specific indications
- Major head and neck surgery
- Airway compromise
- Swelling
- Lateral cephalogram
- Head/neck CT
- Head/neck MRI
- Performed only under specific indications
- Extraoral
- Significant facial deformity/asymmetry
- Significant maxillary/mandibular discrepancy
- Upper lip bite test
- Previous head and neck radiation
- Limited mouth opening
- Facial burns
- Infection/swelling
- Obesity
- Facial hair
- Cervical considerations
- Neck circumference
- Short neck
- Neck flexion/extension
- Thyromental distance
- Intraoral
- Loose/missing teeth
- Infection/swelling
- Central incisor prominence
- Maximal interincisal distance on opening
- Removable devices
- Mallampati Score (Figure 3.16)
- Brodsky Score (Figure 3.17)
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