Physical Examinations

General Examination

It is case oriented and should be done thoroughly.

• Vital signs heart rate, respiratory rate, temperature, blood pressuredocumentation is important especially in patient with cerebrovascular or cardiovascular disease

• General appearances and clinical signs• Eg: patient with underlying hepatobiliary disease

presented with jaundice.

Airway Assessment

• It is paramount to identify patients who may pose problems in airway management

• Difficult intubation refers to airway that presents problems related to laryngoscopy and intubation/ this procedure require more than 3 attempts by properly trained doctors

• Predictors of difficult intubation : Mallampati Classification with Samsoon and Young ModificationThyromental Distance (TMD)Cervical spine Movement

Mallampati Classification

• It relates to the amount of mouth opening to the size of the tongue

• provides an estimate of space for oral intubation by direct laryngoscopy

• Class 1 predicts grade 1 Cormac and Lehane in more than 99% of the time

• Class 4 laryngoscopic view is grade 3 /4 Cormac and Lehane in 100% of time

Thyromental Distance (TMD)

• Thyromental distance of < 6.5cm may predict a difficult intubation

• It is measured from upper edge of thyroid cartilage to the chin with the head fully extended

•Eg: Patient with underlying thyroid disease can have short TMD, thus leads to a possible of difficult intubation.

Interincisor Distance (IDD)

•Less than or equal to 4.5cm is considered a potentially difficult intubation.

•Generally greater than 2.5 to 3 fingerbreadth depending on observer’s fingers

Sternomental Distance (SMD)

•It is measured from upper border of manubrium to the tip of mandible.

•A distance of <12.5cm is a difficult intubation.

Cervical spine movement• This involves the assessment of the full

range of movement at atlanto-occipital joint (flexion, extension and rotation)

• The range of movement is important for proper positioning of the head (extension) and neck (flexion) for visualization of vocal cords during laryngoscopy.

• Examples: ankylosing spondylitis, spinal cord injury.

Cardiac Examination

• It includes an assessment of the rate, rhythm, and murmurs.

Pulmonary examination

• To assess the severity of illness and guides the anesthesia plan. Eg: underlying COAD

Neurological and Musculoskeletal examination

• A neurologic examination is important when planning a regional anesthetic and before procedures with possible neurologic complications

• Musculoskeletal evaluation may detect ankylosing spondylitis, scoliosis or severe rheumatoid arthritis which may cause difficult intubation or anesthethic procedures