This handout is for preoperative airway evaluation and difficult airway management. Your care team identified this based on: preoperative anesthesia evaluation visit (any surgery requiring airway management) (asa 2022).
Other reasons your team may use this plan: prior documented difficult intubation / failed intubation / surgical airway (asa 2022); severe osa, bmi >=40, history of failed mask ventilation (asa 2022); head/neck pathology — tumor, radiation, ra, ankylosing spondylitis, down syndrome, pierre robin, micrognathia (asa 2022, das 2015).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| lidocaine_topical | 4% nebulized 4-6 mL + 2-4% spray-as-you-go; maintain total dose under 9 mg/kg LBW | topical/nebulized | preinduction | Topical airway anesthesia for awake intubation; track cumulative dose to avoid LAST (ASRA 2020, ASA 2022) |
| midazolam | 0.5-2 mg IV titrated | IV | titrated to anxiolysis with patient cooperation preserved | Anxiolysis without obtunding cooperation (ASA 2022, DAS 2015) |
| remifentanil | TCI 1-3 ng/mL or 0.05-0.1 mcg/kg/min | IV | continuous | Antitussive + analgesia; rapid offset preserves spontaneous ventilation (ASA 2022, DAS 2015) |
Plan: Difficult Airway — ASA 2022 + DAS 2015 induction / rescue / reversal medications
Contact your care team if any of the following happen:
Document difficult intubation on chart + MedicAlert; postop airway debrief (especially after CICO or front-of-neck access); patient counseling + future anesthetic-plan letter; Difficult Airway Society registry case report (ASA 2022, DAS 2015)
Guideline: 2022 ASA Practice Guidelines for Management of the Difficult Airway (Apfelbaum et al, Anesthesiology 2022) + DAS 2015 (Frerk, BJA 2015) + NAP4 (Cook et al, BJA 2011) + Mallampati 1985