increases the severity of airway edema and
bleeding, and decreases the chance of success,
even with more specialized methods.
The most reliable predictor of a difficult intu-
bation is the patient's history. If a previous anes-
thetic record is available, review it. Focus physi-
cal exams on anatomic anomalies involving the
head, face or neck. Check the size and mobility
of the mandible. A small, malformed or immo-
bile mandible is the most reliable physical pre-
dictor of a difficult intubation. Look for anatom-
ic features that cause distortion of the airway.
Ask about symptoms of obstructed airways, like
snoring. Be sure to have all necessary airway
equipment in the OR, including anything that
might be needed for 2
nd
, 3
rd
and even 4
th
options. Different-sized laryngoscope blades
and endotracheal tubes (cuffed and uncuffed)
should be within easy reach. If you know a child
is likely to be difficult to intubate, it's a good
idea to secure IV access while the child is still
awake, if possible.
Indirect techniques
Indirect techniques include video laryn-
goscopy, intubating LMA, optical stylet, light-
ed stylet and the flexible fiberoptic broncho-
scope. The choice largely depends on your
experience and preference, but it may also be
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