++
Chapter 25: Evaluation of the Patient and Preoperative Preparation
++
++
++
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?
++
++
++
++
++
(B) neck thickness of 16 inches
++
++
++
++
(D) uvula visible when tongue protruded
++
++
(E) thyromental distance greater than 3 finger breadths
+
++
The answer is C. Narrow palate is considered a nonreassuring airway exam finding suggestive of difficult intubation. Other nonreassuring airway exam findings include:
++
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
++
++
Refs: Miller RD. Miller's Anesthesia, 8th ed. Philadelphia, PA: Elsevier; 2015.
++
American Society of Anesthesiologists, Practice guidelines for management of the difficult airway: an updated report. Anesthesiology 2013;118:1269–1277.
++
++
++
According to the Mallampati classification of the airway, direct visualization of a Class III airway would reveal:
++
++
++
++
++
(B) soft palate, fauces, uvula
++
++
(C) soft palate, tip of epiglottis
++
++
(D) soft palate, fauces, uvula, pillars
++
++
(E) soft palate, base of uvula
+
++
The answer is E. For the Mallampati classification of the airway, the following anatomic landmarks are visible during direct visualization with the patient seated:
++
I—soft palate, fauces, uvula, pillars
II—soft palate, fauces, uvula
III—soft palate, base of uvula
IV—hard palate only
++
The epiglottis is typically viewed with direct laryngoscopy. Cormack and Lehane's classification is used to describe laryngoscopic views.
++
++
Ref: Miller RD. Miller's Anesthesia, 8th ed. Philadelphia, PA: Elsevier; 2015.
++
++
++
A 44-year-old ASA I patient scheduled for a mandibular osteotomy requires which of the following routine preoperative tests?
++
++
++
++
++
++
++
++
++
++
++
+
++
The answer is E. Determining appropriate preoperative laboratory studies is a controversial ...