Table 3.
The AMF Suggested Method of Assimilation of Assessments to Aid Airway Management Planning
| Areas | Available, Difficult or Impossible? | Optimization needed for Difficult (some examples) | ||
|---|---|---|---|---|
| Cooperation | A/D/I | Attendants/Medication* | ||
| Mask ventilation | A/D/I | OPA, NPA, Case specific† | ||
| SAD placement | A/D/I | 2nd generation SAD, Preshaped SADs, Laryngoscope, Bougie‡ | ||
| Laryngoscopy | A/D/I | OELM, other blades (e.g., McCoy blade), Videolaryngoscope, Fiberscope, Case specific§ | ||
| Intubation | A/D/I | Stylet, Bougie, Magill forceps, Cuff inflation,[19] Case specific║ | ||
| Front of neck access | A/D/I | Bandage removal, Scar incision, Ultrasound-guided | ||
| Emergence | A/D/I | Fully awake, Bailey’s maneuver,[20] AEC¶ | ||
| Resources | Available? | |||
| Equipment | Yes/No | |||
| Knowledge and Skills | Yes/No | |||
| Extra hand | Yes/No | |||
| Paraoxygenation** | Yes/No | |||
| Fall back capabilities†† | Yes/No | |||
| Surgical requirement | Possible? | |||
| Special patient position | Yes/No | Yes/No | ||
| Airway shared | Yes/No | Yes/No | ||
| Airway manager’s mindset | Possible? | |||
| Is intubation MUST? | Yes/No | Yes/No | ||
| Can SAD be the definitive airway device? | Yes/No | Yes/No | ||
* - Attendant is allowed inside the operation theater to comfort the patient (for children or patients with a handicap (mentally or physically challenged); very small (¼ to ½ of the usual) dose of anxiolytic may be considered. †e.g., cling film for beard, gauze pieces to puff out cheeks, ramping for obese, etc., OPA-oropharyngeal airway, NPA-nasopharyngeal airway. ‡Bougie-guided introduction requires gentle pharyngoscopy as well.[21]. § - e.g., gauze pack for missing incisors or cleft palate, ramping for obese, etc., OELM-optimum external laryngeal manipulation. ║e.g., gauze pack for missing incisors or cleft palate. ¶In addition to these optimization options that suggest that the airway device will be removed on the table itself, the airway manager can either defer the removal of the airway device till the airway and patient have stabilized or perform tracheostomy before removal of the airway device. AEC - airway exchange catheter. **e.g., Nasal prong, Auxiliary O2 flow, High flow nasal cannula (HFNC)/ Transnasal humidified rapid insufflation ventilatory exchange (THRIVE). Please remember that paraoxygenation may be difficult or impossible in the presence of blocked bilateral nasal passages, while attempting nasal intubation in the presence of large oral swelling and in the presence of large laryngeal or tracheal swelling/foreign body. ††e.g., ICU or a higher referral center