plan B."
Dr. Dutton says advanced pre-op plan-
ning remains "over the horizon." A basic
physical exam has been best practice for
decades. "Open your mouth, stick out your
tongue," he says. "We look at their neck;
can they move their head around? We get
the traditional Mallampati score. And if
you're doing a really difficult case, you
might have CT scans or MRIs to look at
ahead of time to see where the airway is."
But Dr. Dutton is intrigued by an emerg-
ing technique called flexible nasopharyn-
goscopy — "taking a very small, short fiber
optic bronchoscope, sticking it in the patient's nose, and looking at the
back of the throat." He says the technique is widely used by ENT sur-
geons, but as it gets easier and cheaper, it's being used to resolve ques-
tions about patient airways and mouth/throat anatomy.
"It's easy to put it in somebody's nose, even without any anesthesia
or topical or local, and take a look around," says Dr. Dutton. "Doing
this pre-operatively is soon going to be a best practice for assessing
the difficult airway. This direct look with a scope is far and away the
best way to assess the anatomy so we can be fairly confident if we
put a video laryngoscope in the patient. The real danger in intubation
is when you stick the laryngoscope in and stuff isn't where it's sup-
posed to be, either because it's been pushed out of the way or
because there's something like a mass in the way."
Flexible nasopharyngoscopy could help your providers avoid sur-
prises and know that the airway is open and everything's where it's
supposed to be. As they say, better to know than to assume.
OSM
J A N U A R Y 2 0 2 0 • O U T PA T I E N T S U R G E R Y. N E T • 8 3
• PLAN AHEAD Devising a safe plan for diffi-
cult airways pre-operatively can prevent sur-
prises in the OR.
