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Chapter 25: Evaluation of the Patient and Preoperative Preparation

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Airway evaluation is recommended in all patients to detect characteristics suggestive of difficult intubation. For a male patient, which of the following findings on airway evaluation may suggest difficult intubation?

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(A) presence of a beard

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(B) neck thickness of 16 inches

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(C) narrow palate

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(D) uvula visible when tongue protruded

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(E) thyromental distance greater than 3 finger breadths

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The answer is C. Narrow palate is considered a nonreassuring airway exam finding suggestive of difficult intubation. Other nonreassuring airway exam findings include:

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  • relatively long incisors

  • prominent “overbite”

  • inability to bring mandibular incisors in front of maxillary incisors

  • interincisor distance <3 cm

  • Mallampati class >2 (uvula not visible when tongue is protruded)

  • highly arched palate

  • thyromental distance <3 finger breadths

  • short, thick neck (>17 inches in men, >16 inches in women)

  • inability to touch tip of chin to chest

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Refs: Miller RD. Miller's Anesthesia, 8th ed. Philadelphia, PA: Elsevier; 2015.

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American Society of Anesthesiologists, Practice guidelines for management of the difficult airway: an updated report. Anesthesiology 2013;118:1269–1277.

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According to the Mallampati classification of the airway, direct visualization of a Class III airway would reveal:

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(A) hard palate only

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(B) soft palate, fauces, uvula

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(C) soft palate, tip of epiglottis

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(D) soft palate, fauces, uvula, pillars

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(E) soft palate, base of uvula

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The answer is E. For the Mallampati classification of the airway, the following anatomic landmarks are visible during direct visualization with the patient seated:

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  • I—soft palate, fauces, uvula, pillars

  • II—soft palate, fauces, uvula

  • III—soft palate, base of uvula

  • IV—hard palate only

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The epiglottis is typically viewed with direct laryngoscopy. Cormack and Lehane's classification is used to describe laryngoscopic views.

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Ref: Miller RD. Miller's Anesthesia, 8th ed. Philadelphia, PA: Elsevier; 2015.

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A 44-year-old ASA I patient scheduled for a mandibular osteotomy requires which of the following routine preoperative tests?

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(A) PTT/PT

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(B) electrolytes

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(C) ECG

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(D) CXR

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(E) no tests

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The answer is E. Determining appropriate preoperative laboratory studies is a controversial topic.

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