SAQ 179 – Airway – difficult intubation assessment and preparation

Question 4. difficult intubation assessment and preparation.

a. Difficult intubation assessment

• Look externally for obesity, a short neck, high-arched palate, or facial and neck trauma.
• Evaluate the 3:3:2 rule.
• Mallampati class.
• Airway obstruction, such as tumour, epiglottitis, or recent neck surgery.
• Neck mobility.
• Other anatomical, physiological, or pathological variation.

b. Preparation for a difficult airway

• Review prior airway records for successful devices or techniques.
• Call for additional assistance early.
• Consider fibreoptic or video-laryngoscopic intubation.
• Optimise positioning and assemble difficult-airway equipment.
• Consider ketamine or gaseous induction.
• Plan for failure, including immediate surgical airway capability.

c. Confirming tube position

• Continuous end-tidal CO2 waveform or level.
• Direct visualisation of the tube passing through the cords.
• Symmetrical chest rise and bilateral breath sounds, with no epigastric sounds.
• Oesophageal aspiration test.