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Part 2. Preparing for Anesthesia
Section B. Preoperative Evaluation of the Anesthesia Patient
Chapter 8. Evaluation of the Patient with a Difficult Airway
James C. Phero, DMD, Andranik Ovassapian, MD, and William E. Hurford, MD
1. A patient with a history of difficult intubation should be treated as having a difficult airway, even though physical appearance and physical examination may be unremarkable.
2. A patient with anatomic variations indicative of possible difficult intubation should receive a careful history and physical examination to define the scope of the potential airway problem.
3. Possible or potentially difficult intubation may be predicted by the Mallampati test, evidence of receding mandible, limited mouth opening as a result of tissue or TMJ restriction, enlarged teeth, high arched palate, narrow small mouth, or restricted cervical spine movement.
4. All tests to predict difficulty with airway management are associated with a high incidence of false-positive and false-negative results and have low predictive value. To minimize airway-related complications, it may be necessary to accept a high incidence of false-positive predictions by the various tests and treat any patient identified as having a possible difficult intubation accordingly.
5. Unexpected failed ventilation and intubation may result from a supraglottic mass or lingual tonsillar hyperplasia that may not be identified by external examination.
6. In pediatrics, infection-related airway compromise and congenital airway malformations..."
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