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Anatomical indicators
If the patient's documentation doesn't signal airway difficulties, their anatomy
can frequently be relied upon to tell the tale. Any anesthesia provider should be
able to detect difficult airways through pre-surgical evaluations.
• Mouth opening.
Establishing an airway is contingent on the range of motion
of the mandible since the maxilla is immobile. I ask patients to bite their upper
lip with their lower teeth. If they can't articulate their lower jaw, due to tem-
poromandibular joint disorder or other conditions, and if they have a hard time
opening up for an examination of the anatomy inside, that's a clear sign to
expect a difficult airway.
• Neck injuries.
Sometimes an airway difficulty is the result of a neck injury or
a previous surgery to repair it. Patients suffering from cervical radiculopathy or
herniated disks, for instance, might not be able to extend their necks, and anes-
thesia providers should be wary of causing further damage. Cervical fusion sur-
gery implants rods, plates, screws or other hardware to join the vertebrae and
immobilize the joints, which doesn't leave the patient with good prospects for
extending the neck.
• Excess weight.
Overweight and obese patients are another group that is likely
to present difficulties. The weight of the tissue in a thick neck or large breasts
can easily threaten to collapse the airway, especially when a patient is posi-
tioned on her back. It also makes lifting and supporting the patient's head a
strain for the anesthesia provider seeking to place an endotracheal tube.
• Risky situations.
Other patients who might present with airway difficulties —
although perhaps less likely to be seen in outpatient surgery settings — include
patients with congenital anomalies that affect the structure of the face, such as
Down syndrome, Pierre Robin syndrome or Treacher Collins syndrome; oral or
head and neck cancer patients whose airways may be obstructed by a tissue
mass; trauma patients who have blood in their mouth; or patients who are cod-
ing, when intubation must be conducted while chest compressions are given.
If your anesthesia staffing involves an anesthesiologist who performs the pre-
A I R W A Y M A N A G E M E N T
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