title: Preoperative endoscopic airway examination (PEAE) provides superior airway information and may reduce the use of unnecessary awake intubation.
abstract: BACKGROUND
  Development of a perioperative plan for management of patients with airway pathology is a challenge for the anesthesiologist. Lack of comprehensive information regarding the architecture of airway lesions often leads the clinician to consider techniques of awake intubation (AI) to avoid catastrophic outcomes in this population. In one uncontrolled trial, endoscopic visualization of the airway lesion was included in the preoperative anesthetic assessment for planning of airway management. We sought to determine whether visual inspection of airway pathology would change the anesthesiologist's approach to the management of these patients.
  
  
  METHODS
  Patients presenting for elective diagnostic or therapeutic airway procedures were included in the study. After a standard examination of the airway, a management plan was recorded. Before entering the operating room, and after brief preparation of the nares with a vasoconstrictor and local anesthetic, the patients underwent a preoperative endoscopic airway examination (PEAE) and a final airway management plan was recorded and implemented. Four or more months after the procedure, video recordings of the PEAE were reviewed without other patient identifiers and a remote PEAE plan was recorded, to test for operator bias.
  
  
  RESULTS
  One hundred thirty-eight patients were studied. Although AI was initially planned in 44 patients, only 16 of these patients underwent preinduction airway control after PEAE (P > 0.05). Additionally, of the 94 patients for whom the initial plan was airway control after the induction of anesthesia, 8 patients were found to have unexpectedly severe airway pathology on PEAE, and also underwent AI. There was no significant difference between the post-PEAE airway management plan and the remote plan recorded 4 or more months later.
  
  
  CONCLUSIONS
  In 26% of the patients studied, PEAE affected the planned airway management. We believe that PEAE can be an essential component of the preoperative assessment of patients with airway pathology; airway visualization reduces the number of unnecessary AIs while providing superior information about the airway architecture. PEAE could be applied to other populations of patients at risk for airway control failure with the induction of anesthesia.
authors.affiliation: Department of Anesthesiology, Yale University School of Medicine, 333 Cedar St., TMP 3, P.O. Box 208051, New Haven, CT 06520-8051, USA. will.rosenblatt@yale.ed
authors.forename: William
authors.initials: W
authors.lastname: Rosenblatt
authors.forename: Andreea I
authors.initials: AI
authors.lastname: Ianus
authors.forename: Wariya
authors.initials: W
authors.lastname: Sukhupragarn
authors.forename: Alexandra
authors.initials: A
authors.lastname: Fickenscher
authors.forename: Clarence
authors.initials: C
authors.lastname: Sasaki
mesh_terms: D000328:Adult; D000368:Aged; D058109:Airway Management / Q000379:methods*; D001999:Bronchoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods*; D012307:Risk Factors; D014851:Wakefulness