A new approach to airway assessment— “Line of Sight” and more. Recommendations of the Task Force of Airway Management Foundation (AMF)

• Main Authors: Rakesh Kumar, Sunil Kumar, Anil Misra, Neera G Kumar, Akhilesh Gupta, Prashant Kumar, Divya Jain
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2020-01-01
• Series: Journal of Anaesthesiology Clinical Pharmacology
• Subjects: airway assessment; airway management; covid-19; line of sight; mnemonic; pandemic; paraoxygenation
• Online Access: http://www.joacp.org/article.asp?issn=0970-9185;year=2020;volume=36;issue=3;spage=303;epage=315;aulast=Kumar

Assessment of airway is recommended by every airway guideline to ensure safe airway management. Numerous unifactorial and multifactorial tests have been used for airway assessment over the years. However, there is none that can identify all the difficult airways. The reasons for the inadequacy of these methods of airway assessment might be their dependence on difficult to remember and apply mnemonics and scores, inability to identify all the variations from the “normal” , and their lack of stress on evaluating the non-patient factors. Airway Management Foundation (AMF) experts and members have been using a different approach, the AMF Approach, to overcome these problems inherent to most available models of airway assessment. This approach suggests a three-step model of airway assessment. The airway manager first makes the assessment of the patient through focused history, focused general examination, and focused airway assessment using the AMF “line of sight” method. The AMF “line of sight” method is a non-mnemonic, non-score-based method of airway assessment wherein the airway manager examines the airway along the line of sight as it moves over the airway and notes down all the variations from the normal. Assessment of non-patient factors follows next and finally there is assimilation of all the information to help identify the available, difficult, and impossible areas of the airway management. The AMF approach is not merely intubation centric but also focuses on all other methods of securing airway and maintaining oxygenation. Airway assessment in the presence of contagion like COVID-19 is also discussed.