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![Page 1: Topics in Airway Management: Intelligent Airway Evaluation Donald M. Voltz, MD Assistant Professor of Anesthesiology Case Western Reserve University](https://reader036.fdocuments.net/reader036/viewer/2022062407/56649ce45503460f949b0bd0/html5/thumbnails/1.jpg)
Topics in Airway Management:Intelligent Airway Evaluation
Donald M. Voltz, MDAssistant Professor of Anesthesiology
Case Western Reserve University / University Hospitals of Cleveland
3 November 2004
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What we focus on and our mental models determine what
we see.
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What is Intelligence?
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Turing Test
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Intelligence = Prediction
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Is There Such a Thing as an Unexpected Difficult Intubation?
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What is the Problem?
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“More than 85% of respiratory-related closed claims involve a
brain-damaged or dead patient.”
Jonathan Benumof, MD
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Incidence of Difficult Intubation
• Successful with multiple attempts
• Successful, many attempts, many people
• Unsuccessful• Can not ventilate or
intubate
• 100-1800/10,000
(1-18%)• 100-400/10,000
(1-4%)• 5-35/10,000
(0.05-.35%)• 0.01-2/10,000
(0.0001-0.02%)
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What do we want to Predict?
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Cormack-Lehane Classifications
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Airway Prediction Models
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Airway Prediction Models
• Mallenpatti Classification
• Neck Range of Motion
• Thyromental/Thyrosternal Distance
• Upper Lip Bite Test
• Multivariate Analysis
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Mallinpatti Classification
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Mallinpatti Classification
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Upper Lip Bite Test
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Upper Lip Bite TestTable 1. Relationship Between the Results of Two Predicting Tests and Laryngoscopy Grades in 300 Patients
I and II III and IV Predicting test
Modified Mallampati
Classes I and II 189 3
Classes III and IV 94 14
Upper lip bite
Classes I and II 251 4
Class III 32 13
Laryngoscopic view
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ASA Difficult Airway ASA Difficult Airway AlgorithmAlgorithm
Updated 2003Updated 2003
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Airway Evaluation
Mouth (4)
Oral Cavity (3)
Neck (4)
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Airway Evaluation - Mouth
• Length of Upper Incisors
• Relationship of Maxillary Incisors to Mandibular Incisors
• Ability to Prognath the Mandible
• Interincisor Distance
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Airway Evaluation – Oral Cavity
• Visibility of the Uvula
• Shape of the Palate
• Compliance of the Mandibular Space
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Airway Evaluation - Neck
• Thyromental/Thyrosternal Distance
• Length of the Neck
• Thickness of the Neck
• Range of Motion of the Head and Neck
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Approaching the Difficult Airway Algorithm
William H. Rosenblatt, M.D.
Yale University School of Medicine
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Is Airway Management Required?
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Do you predict difficult direct laryngoscopy?
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Will superlarngeal ventilation be possible?
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Predictors of Difficult Mask Ventilation
• Age greater than 55 years
• Body mass index greater than 26 kg/m2
• History of snoring
• Edentulous
• Presence of facial hair
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Is the patient at an increased risk of aspiration?
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Will the patient tolerate a judgment error?
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Problems with Prediction Methods
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Future of Airway Prediction
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References
• Rosenblatt, W.H. Decision making in airway evaluation. ASA Refresher Course in Anesthesiology, V. 32, 2004.
• Benumof, J.L. Airway Management, pp. 121-158, 1996.
• ASA Task Force on Airway Management. Practice Guidelines for Management of the Difficult Airway: An Updated Report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway, Anesthesiology, 98(5), 1269-1277.