Physical

Examinations
General Examination
It is case oriented and should be done thoroughly.
Vital signs
heart rate, respiratory rate, temperature, blood
pressure
documentation 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
Modification
Thyromental 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 observers
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