Large neck OSA may be a risk of obstruction – Mallampati and Larynx Grading I : Visualization of the soft palate, fauces; uvula, anterior and the posterior pillars. Class II : Visualization of the soft palate, fauces and uvula. Class III : Visualization of soft palate and base of uvula. Class IV: Only hard palate is visible. Soft palate is not visible at all I Visualization of entire laryngeal aperture. – Grade II Visualization of only posterior commissure of laryngeal aperture. – Grade III Visualization of only epiglottis. – Grade IV Visualization of just the soft palate. – LEMON airway assessment method The score with a maximum of 10 points is calculated by assigning 1 for each of the following LEMON criteria: L = Look externally (facial trauma, large incisors, beard or moustache, large tongue) E = Evaluate the 3-3-2 rule (incisor distance-3 finger breadths, distance-3 finger breadths, thyroid-to-mouth distance-2 finger breadths) M = Mallampati (Mallampati score > 3). O = Obstruction (presence of any condition like epiglottitis, peritonsillar abscess, trauma). N = Neck mobility (limited neck mobility) Fasting Requirements Clear Fluids 2hrs – Light meals 6hrs – Heavy meals 8hrs – Reduction of aspiration risk Predisposing factors for aspiration general anaesthesia Patient factors Increased gastric content Intestinal obstruction Non-fasted Delayed gastric emptying Lower oesophageal sphincter incompetence Hiatus hernia Gastro-oesophageal reflux Pregnancy Morbid obesity Neuromuscular disease Decreased laryngeal reflexes Head injury Bulbar palsy Gender Male Age Elderly Operation factors Procedure Emergency
Large neck OSA – may be a risk of obstruction Mallampati and Larynx Grading I : Visualization of the soft palate, fauces; uvula, anterior and the posterior pillars. Class II : Visualization of the soft palate, fauces and uvula. Class III : Visualization of soft palate and base of uvula. Class IV: Only hard palate is visible. Soft palate is not visible at all I – Visualization of entire laryngeal aperture. Grade II – Visualization of only posterior commissure of laryngeal aperture. Grade III – Visualization of only epiglottis. Grade IV – Visualization of just the soft palate. LEMON airway assessment method The score with a maximum of 10 points is calculated by assigning 1 for each of the following LEMON criteria: L = Look externally (facial trauma, large incisors, beard or moustache, large tongue) E = Evaluate the 3-3-2 rule (incisor distance-3 finger breadths, distance-3 finger breadths, thyroid-to-mouth distance-2 finger breadths) M = Mallampati (Mallampati score > 3). O = Obstruction (presence of any condition like epiglottitis, peritonsillar abscess, trauma). N = Neck mobility (limited neck mobility) Fasting Requirements Clear Fluids – 2hrs Light meals – 6hrs Heavy meals – 8hrs Reduction of aspiration risk Predisposing factors for aspiration general anaesthesia Patient factors Increased gastric content Intestinal obstruction Non-fasted Delayed gastric emptying Lower oesophageal sphincter incompetence Hiatus hernia Gastro-oesophageal reflux Pregnancy Morbid obesity Neuromuscular disease Decreased laryngeal reflexes Head injury Bulbar palsy Gender Male Age Elderly Operation factors Procedure Emergency