Anaes Cases · Airway management & difficult airway
The predicted difficult airway — limited mouth opening and neck fixation
A short, focused airway case — the bedside prediction (LEMON), the decision between awake intubation and an optimised induced technique, and the equipment and back-up plan.
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Prompt
A 68-year-old man presents for elective incisional hernia repair. He has a cervical spine fusion with virtually no neck movement and a mouth opening of two finger-breadths. Outline your airway assessment and your plan.
Presentation
A 68-year-old man is booked for an elective incisional hernia repair. He is otherwise well (BMI 28, ex-smoker, hypertension). The airway examination, however, is concerning: he had a cervical spine fusion five years ago and has virtually no neck extension or flexion, his mouth opening is two finger-breadths, his thyromental distance is short, and his Mallampati score is III. He is cooperative and asymptomatic at rest.
References3ShowHide
- [10]De Jong A, Molinari N, Terzi N, et al. Early identification of patients at risk for difficult intubation in the intensive care unit: development and validation of the MACOCHA score. American Journal of Respiratory and Critical Care Medicine, 2013.PMID 23348979
- [3]Apfelbaum JL, Hagberg CA, Connis RT, et al. 2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway. Anesthesiology, 2022.PMID 34762729
- [11]Bersten AD, Soni N (eds) Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.