Table 1.

Grading System Used to Assess Intubating Conditions, Vocal Cord Position, and Patient Comfort and Satisfaction

	Intubating conditions	Vocal cord position	Patient comfort indices			Post-operative patient satisfaction
			Cough severity	Comfort during intubation	Post-intubation assessment
Grade 1	Optimal (no hold-up or collision of tracheal tube with vocal cords)	Relaxed/glottis open	No cough	No reaction	Cooperative	Excellent
Grade 2	Suboptimal (hold-up relieved by one rotation of the tube)	Moving/glottis partially open	Slight (<2 coughs)	Grimacing	Restless/minimal resistance	Good
Grade 3	Difficult (hold-up requiring more than one rotation of the tube)	Adducted/glottis closed	Moderate (3-5 coughs)	Verbal objection	Severe resistance/requirement for immediate general anesthesia	Fair
Grade 4	Failure (failed attempt at awake fiberoptic intubation)	-	Severe (>5 coughs)	Defensive movements	-	Poor