anyone stopped doing airway exam?

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urge

urge

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It's notorious to be unreliable.

I'm more concerned about mouth opening than the actual mallampati classification.

The rest of the 16 tests are even worse.

What are you guys doing?
 
my biggest things are also mouth opening and the presence of teeth (and if present, how large they are). usually if i can get the blade where i want it things go ok, and large teeth and a small mouth are probably the biggest reasons for my tougher intubations. most of the other stuff you can tell just by looking at someone.
 
If they have back problems I'll check neck extension. If they're morbidly obese I'll look in the mouth. Otherwise just a glance for generally normal jaw.
 
If I have a reason to be concerned about the airway then I am more meticulous about documenting a formal exam.

Full stomach, prior neck surgery, a condition that might result in rapid desaturation, grossly abnormal facial features...

-pod
 
Our electronic preop forms have boxes to check for airway, heart and lung exams. It's a QC hit if any are left blank. I'm not going to gundeck it and document something I didn't do ... so I do all those things.
 
I look at them while talking to them, and I eyeball neck thickness, presence of beard or retrognathia, and weight. I do that reflexively, in the same way I reflexively look at their peripheral veins. If t here is something specific about their history or procedure, I will do a more thorough exam.
 
pgg said:
Our electronic preop forms have boxes to check for airway, heart and lung exams. It's a QC hit if any are left blank. I'm not going to gundeck it and document something I didn't do ... so I do all those things.
Click to expand...

I eyeball them and write "ok" in that section.
 
Your kidding right? It takes maybe ten seconds. It is about the only time anesthesiologists touch patients awake in preop. I am assuming that someone who doesn't routinely do an airway exam also doesn't routinely auscultate heart and lungs. Touching a patient is part of establishing rapport. Also I have been surprised more than once when what I found on exam differed from what I expected to find on exam. We all shave wherever we can due to production pressure. But this is not the place.
 
People can do what they want based on tradition, ritual, whatever. But the yield is very low. Eyeball is as good as formal airway exam IMO.

400 pounder with beard? Straight to glidescope. 20yo 50kg woman with normal chin? No further exam necessary.
 
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nimbus said:
People can do what they want based on tradition, ritual, whatever. But the yield is very low. Eyeball is as good as formal airway exam IMO.

400 pounder with beard? Straight to glidescope. 20yo 50kg woman with normal chin? No further exam necessary.
Click to expand...

So you have never had a poor historian who neglected to mention previous radiation therapy that you didn't appreciate till examining them? Someone whose dentition was absolutely horrible that you didn't notice till they opened wide? Somebody whose neck didn't move worth sh1t?, etc. Agree that the yield is low, but it take a few seconds, and I hate surprises.
 
dr doze said:
So you have never had a poor historian who neglected to mention previous radiation therapy that you didn't appreciate till examining them? Someone whose dentition was absolutely horrible that you didn't notice till they opened wide? Somebody whose neck didn't move worth sh1t?, etc. Agree that the yield is low, but it take a few seconds, and I hate surprises.
Click to expand...


Yes to most of the above. And I deal with it. Still I think the exam is unnecessary most of the time.

Some things I find useful. Ultrasound for lines and blocks for example. And I am a huge proponent. But other stuff like airway exam for every normal looking patient is of dubious value. At least some others agree and that's why this question was posed.
 
I examine them always, because I need to have an idea of the pharyngeal space to plan for the right type of LMA. The difference between a good fit and an approximate fit is... sore throat.
 
nimbus said:
People can do what they want based on tradition, ritual, whatever. But the yield is very low. Eyeball is as good as formal airway exam IMO.

400 pounder with beard? Straight to glidescope. 20yo 50kg woman with normal chin? No further exam necessary.
Click to expand...
I wonder the rate of surprises for both approaches, eyeballing vs formal extensive exam.

My ultimate question being whether you reach a level of experience where your gut feeling after eyeballing a patient is better than an airway exam.
 
One of the few times I didn't do a formal exam as a resident, and the patient came back with full dentures with paste that looked to be about 3 days old. Things ended up going fine, but the stress of trying to get those (after DL attempt) loose-but-still-completely-gummed-up dentures out of his mouth was very real and I haven't skimped since. Felt like that could have gone bad fast. Didn't help that it was in front of the attending surgeon.
 
why would you? are you seriously so time pressured that you won't spend 15 seconds to do an airway exam.
Even if the chances are small that you'll gain valuable information about the patients airway - it's 15seconds well spent IMHO.
 
I still do airway exams. Maybe only time I don't really exam fully is for mac cases (even in mac cases if they are really large, I will do an airway exam). Literally takes 10 seconds.
 
urge said:
I wonder the rate of surprises for both approaches, eyeballing vs formal extensive exam.

My ultimate question being whether you reach a level of experience where your gut feeling after eyeballing a patient is better than an airway exam.
Click to expand...

I don't do it in all patients.
If my gut instinct spider sense goes off... then I do an AW exam.

I do believe in your experience statement.
 
I always do a basic AW exam and auscultate heart and lungs for each and every patient I take care of.
If patients and their families don't see us acting like doctors they won't view as as such.
 
So for those who are skimping on the AW exam, are you listening to heart and lungs? I do all, each and every time on every patient. I don't see why not. It takes me a minute to do all of them. Are we really that pressed that we cant spare a minute? I do admit, my practice does have more time between turnovers. If I worked in a crazy fast place, I would have issues. I interviewed for a job in Indiana where the patients didn't see an anesthesiologist till they got to the OR table. Weird.
 
chocomorsel said:
I don't see why not. It takes me a minute to do all of them. Are we really that pressed that we cant spare a minute?
Click to expand...

I don't think anyone has mentioned any time constraints impeding their airway exam. Not sure why you guys keep bringing that up.
 
I approach physical exam tests the same way I do lab tests- from a standpoint of pretest probability, and the likelihood of a positive (abnormal) result changing my management.

As such, for an athlete having a knee scope, no, I don't listen to their heart or lungs. If I heard a murmur, would I cancel the case and send the patient for echo? Nope. So why lay my MRSA-covered stethoscope on them when it won't change what I do? Just to make a show of my doctorhood? Not how I roll.

A sicker patient who isn't active, and doesn't have a recent echo? Yeah, I'd probably take a listen. But I'd be more likely to use a VScan portable echo than I would a stethoscope. In my VScan-holding hands, a stethoscope is essentially obsolete.

But yeah, if I think I might hear something that would change the way I'd go about the case, I'll listen.

But here's the thing- I anesthetize every elderly, sick, or frail patient as if they had a tight left main and tight AS. So it almost never changes my management anyway.
 
Most of what I need to know is learned through the history. It is probably 80% history, 20% physical. But I do the physical.

I ask about poor teeth, especially chipped and loose ones. That has proven important in several cases I was supervising. Oddities are noted. Large teeth, underbite, overbite, small chin, limited extension or flexion, large tongue. Otherwise a M1, FROM, no loose teeth suffices.

It is easy to auscultate when I tell them, "I need to make sure you have a heart". It usually gets a chuckle from a family member saying, "that is debatable". I don't do the full heart exam repeated supine, sitting, and leaning forward of visualization, palpation, percussion, and auscultation in 4 locations. That would be too much.

I commonly listen left and right for the lungs. Asthmatics or COPDers getting a bit more attention.
 
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