Preoperative Airway Evaluation

Purpose of Review This paper provides an updated review on preoperative airway assessment, the factors that are used to predict a difficult airway, and whether difficulty can be accurately predicted. Recent Findings Traditional history and examination features have focused on prediction of difficult intubation, but recent studies attempt to predict difficulty with other aspects of managing the airway including bag-mask ventilation, supraglottic airway (SGA) ventilation, and front-of-neck access. A recent Cochrane review confirms that traditional examination findings lack diagnostic accuracy for detection of difficult airways. There is promise in the use of airway imaging techniques including endoscopy and ultrasound, for preoperative prediction of difficult airways. Summary Despite thorough assessment, a significant percentage of airway difficulties will continue to be unanticipated, and there is no single test, or combination of tests, that can accurately and reliably predict a difficult airway. The anesthesiologist should be prepared for unanticipated difficulty, as prediction remains imprecise. Further studies are required to refine the specific parameters and measurements expected for newer imaging modalities which might be beneficial, including airway ultrasound and endoscopy.