Difficult Airway Assessment Mnemonics

Difficult airway assessment mnemonics are valuable tools in critical patient situations, aiding in the systematic evaluation of the airway and contributing to improved patient outcomes. The use of mnemonics such as LEMON and MOANS has been supported as a standard way to assess difficult airways in emergency department settings (Saoraya et al., 2021). These mnemonics aid in the systematic and evidence-based assessment of the airway, which may reduce the incidence of unanticipated difficult airway management (Nørskov et al., 2013). Additionally, the Difficult Airway Society guidelines emphasize the importance of cognitive aids, such as the Vortex Approach, to support decision-making during difficult airway management (Frerk et al., 2015). Furthermore, the American Society of Anesthesiologists (ASA) Difficult Airway Algorithm provides guidelines for the assessment and management of the airway, highlighting the significance of a structured approach in critical airway situations (Truong et al., 2018).

In the context of preoperative assessment, the use of mnemonics and predictive indicators for difficult airway assessment is vital for identifying potential predictors of a difficult airway (Sonavdekar & Nayak, 2016). The accurate prediction of difficult airway management is essential for reducing potential complications by allowing the allocation of experienced personnel and the use of relevant equipment (Nørskov et al., 2014). Moreover, the need for a strategy incorporating extubation is mentioned in international airway management guidelines, emphasizing the importance of comprehensive airway assessment throughout the patient care continuum, including extubation of patients with a difficult airway (Mitchell et al., 2012).

References:

• Frerk, C., Mitchell, V., McNarry, A., Mendonca, C., Bhagrath, R., Patel, A., … & Ahmad, I. (2015). Difficult airway society 2015 guidelines for management of unanticipated difficult intubation in adults. British Journal of Anaesthesia, 115(6), 827-848.
  https://doi.org/10.1093/bja/aev371
• Mitchell, V., Dravid, R., Patel, A., Swampillai, C., & Higgs, A. (2012). Difficult airway society guidelines for the management of tracheal extubation. Anaesthesia, 67(3), 318-340.
  https://doi.org/10.1111/j.1365-2044.2012.07075.x
• Nørskov, A., Rosenstock, C., Wetterslev, J., & Lundstrøm, L. (2013). Incidence of unanticipated difficult airway using an objective airway score versus a standard clinical airway assessment: the difficair trial – trial protocol for a cluster randomized clinical trial. Trials, 14(1), 347.
  https://doi.org/10.1186/1745-6215-14-347
• Nørskov, A., Rosenstock, C., Wetterslev, J., Astrup, G., Afshari, A., & Lundstrøm, L. (2014). Diagnostic accuracy of anaesthesiologists’ prediction of difficult airway management in daily clinical practice: a cohort study of 188 064 patients registered in the danish anaesthesia database. Anaesthesia, 70(3), 272-281.
  https://doi.org/10.1111/anae.12955
• Saoraya, J., Vongkulbhisal, K., Kijpaisalratana, N., Lumlertgul, S., Musikatavorn, K., & Komindr, A. (2021). Difficult airway predictors were associated with decreased use of neuromuscular blocking agents in emergency airway management: a retrospective cohort study in thailand. BMC Emergency Medicine, 21(1).
  https://doi.org/10.1186/s12873-021-00434-2
• Sonavdekar, S. and Nayak, M. (2016). Predictors of difficult airway: preoperative assessment. Journal of Evolution of Medical and Dental Sciences, 5(36), 2163-2168.
  https://doi.org/10.14260/jemds/2016/504
• Truong, A., Truong, D., & Rahlfs, T. (2018). Trs score: proposed mnemonic for airway assessment and management in patients with head and neck cancers. Head & Neck, 40(12), 2757-2758.
  https://doi.org/10.1002/hed.25502