RT Book, Section
A1 Phero, James C.
A1 Patil, Yash J.
A1 Hurford, William E.
A2 Longnecker, David E.
A2 Brown, David L.
A2 Newman, Mark F.
A2 Zapol, Warren M.
SR Print(0)
ID 56622740
T1 Chapter 10. Evaluation of the Patient with a Difficult Airway
T2 Anesthesiology, 2e
YR 2012
FD 2012
PB The McGraw-Hill Companies
PP New York, NY
SN 978-0-07-178513-6
LK accessanesthesiology.mhmedical.com/content.aspx?aid=56622740
RD 2024/04/23
AB A  patient  with  a  history  of  difficult  intubation  should  be  treated  as  having  a  difficult  airway,  even  though  physical  appearance  and  physical  examination  may  be  unremarkable.A  patient  with  anatomic  variations  indicative  of  possible  difficult  intubation  should  receive  a  careful  history  and  physical  examination  to  define  the  extent  of  the  potential  airway  problem.Possible  or  potentially  difficult  intubation  may  be  predicted  by  the  Mallampati  test,  evidence  of  receding  mandible,  limited  mouth  opening  as  a  result  of  tissue  or  temporomandibular  joint  (TMJ)  restriction,  enlarged  teeth,  high  arched  palate,  narrow  small  mouth,  or  restricted  cervical  spine  movement.All  current  tests  to  predict  difficulty  with  airway  management  are  associated  with  a  high  incidence  of  false-positive  and  false-negative  results  and  have  low  predictive  value.  To  minimize  airway-related  complications,  it  is  optimal  to  accept  a  high  incidence  of  false-positive  predictions  by  the  various  tests  and  treat  any  patient  identified  as  having  a  possible  difficult  intubation  accordingly.Unexpected  failed  ventilation  and  intubation  may  result  from  oropharyngeal,  laryngeal,  or  tracheal  pathology  that  may  not  be  identified  by  external  examination.In  pediatrics,  infection-related  airway  compromise  and  congenital  airway  malformations  are  the  major  airway  management  problems.In  adults,  stridor  at  rest  indicates  a  serious  degree  of  obstruction  with  a  cross-sectional  opening  less  than  4  mm.Upper  airway  endoscopy  with  a  standard  or  videolaryngoscope  and/or  fiberoptic  bronchoscope  is  useful  in  defining  anatomic  challenges  in  patients  with  upper  airway  pathology  before  induction  of  general  anesthesia.