Sniffing Position

  • Physiologically aligns:
    • oral axis
    • pharyngeal axis
    • laryngeal axis
Sniffing Position

Malampati Classification

Malampati Classification
  • Class 1: Soft palate, uvula, tonsillar pillars can be seen
  • Class 2: As above except tonsillar pillars are not seen
  • Class 3: Only base of uvula is seen
  • Class 4: Only tongue and hard palate can be seen.

Cormack-Lehane Views

Cormack Lehane Views
  • Grade 1: full glottic exposure
  • Grade 2: only posterior commissure of the glottis seen
  • Grade 3: No exposure of glottis
  • Grade 4: No exposure of the glottis or of the corniculate cartilage

Pediatric Airway

Pediatric patients have anatomic differences that make tracheal intubation more challenging.

  • Epiglottis is floppy and more difficult to manipulate.
  • Larynx lies at a more superior level C3-C4 as opposed to the adult, where lies at C4-C5. This is an important anatomic consideration to have in mind for the correct placement of the ETT and position of the tip.
  • The anterior attachment of the vocal cords is more caudal so they are not perpendicular to the airway as they are in the adults.

These factors make it necessary to displace the tongue and mandible more in order to visualize the infant’s vocal cords. Therefore, straight laryngoscopes blades (Miller blades) are used more commonly to intubate the trachea of children.

  • Endotracheal tube
  • Size (mm): (age/4)+4 OR (height[cm]/20)
  • Distance at lips (cm) = 3 x size(mm), Nasal = 4 x size(mm)
  • Age ≤ 8: uncuffed ET tube
Pediatric Airway