EVALUATION OF THE AIRWAY

History

A documented history of difficulties with general anesthesia or, more specifically, mask ventilation or endotracheal intubation should immediately arouse concern regarding a patient's airway, and the information should not be lightly dismissed. If the clinician encounters a difficult airway, it is important to specifically inform the patient about the problems encountered so that this information can be transmitted to the next anesthesia caregiver. Until a searchable national database is available, the patient can be given a form letter providing information on the airway problem.^[5] Even a brief note, such as "difficult mask ventilation and intubation," on the back of a business card provides a handy mobile source of information to future caregivers. The best means of communication may be the use of a MedicAlert bracelet labeled "difficult airway/intubation." The MedicAlert System can be reached at 1-800-344-3226. Previous anesthesia records are extremely useful, especially when the problem is clearly defined. Some diseases, such as rheumatoid arthritis and morbid obesity, might have progressed in the interim and created a more difficult airway than suggested by the previous anesthetic record.

Many congenital syndromes that involve the airway may make mask ventilation or endotracheal intubation difficult. Several excellent sources provide an extensive listing of these, and it may be prudent to keep one of these lists in a readily available place. The more common congenital syndromes and their airway implications are listed in Table 42-2 .

Other diseases of infectious, traumatic, neoplastic, or inflammatory origins may also profoundly affect airway management. Table 42-3 lists many that should be considered while eliciting a patient's history.