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1. Do you conduct pre-op airway exams?
Your anesthesia providers should conduct a pre-op evaluation of the
patient's airway before each case. Although physical characteristics
aren't always associated with intraoperative airway trouble, there
are red flags that can be identified during exams, including relatively
long upper incisors, a prominent overbite, a short, a thick neck and
the inability to visualize the uvula when the patient's tongue is pro-
truded.
2. Do you have a plan in place?
There are 5 categories of difficult airway management options to con-
sider: mask ventilation, supraglottic airway, laryngoscopy, tracheal
intubation and surgical airway. The key is to consider the patient-spe-
cific characteristics and comorbidities that could make maintaining
the airway a challenge, decide which approach would be best and
ensure the required tools are in the OR in the event they're needed.
For example, patients who don't have the ability to open their
mouth fully could be candidates for mask ventilation, but would be
less suited for placement of a supraglottic airway. A history of airway
trouble is also a crucial consideration. When planning endotracheal
intubations on patients who've been difficult intubations in the past,
decide if there are enough warning signs that would call for awake
intubation. If your facility does not have the tools and providers avail-
able to perform that technique, refer the patient to another facility
that does.
3. Do you have the right equipment?
Being prepared to handle difficult airways requires having a fully
stocked airway cart on hand. The American Society of
Anesthesiologists suggests investing in rigid laryngoscope blades,
video laryngoscopes, tracheal tubes, tracheal tube guides, supraglot-
