wide. If the mandibular opening is less than three finger breadths,
there won't be a lot of room to insert and maneuver airway instru-
ments. Additionally, providers could have difficulty establishing the
airway in patients who can't bring their lower teeth in front of their
top teeth, lack adequate mandibular extension or have limited neck
mobility.
• Voice recognition. Nodules, cysts or polyps can cause unforeseen
obstructions after the patient is sedated and tissue around the pharyn-
geal airway relaxes. These internal structures are impossible to identify
before surgery without direct visualization. But a hoarse voice could
serve as a warning sign.
A higher percentage of patients are presenting for outpatient sur-
gery with comorbidities, obesity and sleep apnea, factors that
increase the complexity of managing the airway. Pre-op screenings
can help providers anticipate tricky intubations, but uncertainty
always remains about which patients will pose a challenge.
"Anesthesia professionals never approach intubations with confidence
that they'll be successful," says Dr. Aziz. "They must always have a
back-up plan in place for what they'll do when faced with a difficult
airway."
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