Difficult Airway Algorithm

A 52-year-old man with a history of rheumatoid arthritis and ankylosing spondylitis presents for emergency laparotomy following perforation of a duodenal ulcer. On airway assessment, he has a Mallampati score of IV, limited neck extension due to cervical fusion, and a thyromental distance of 5 cm. Induction is initiated with propofol and succinylcholine. After loss of consciousness, bag-mask ventilation is found to be inadequate, and the first intubation attempt by the senior resident fails. What is the most appropriate next step?

A 52-year-old male with a history of rheumatoid arthritis presents for elective surgery. Preoperative airway assessment reveals limited neck extension (< 35°) and a thyromental distance of 5.5 cm. Which finding would best distinguish atlantoaxial instability (AAI) from simple cervical spondylosis as the primary airway risk factor?

A 52-year-old male with a history of rheumatoid arthritis presents for elective surgery. Pre-operative airway assessment reveals limited cervical spine mobility and a Mallampati score of III. Which anatomical site is most commonly affected in rheumatoid arthritis that contributes most to difficult airway management in this patient?

A 45-year-old male with a history of obstructive sleep apnea (OSA), BMI 38 kg/m², and hypertension is scheduled for elective laparoscopic cholecystectomy under general anesthesia. Preoperative airway assessment reveals Mallampati Grade III, limited neck extension, and a thyromental distance of 5 cm. After induction with propofol and succinylcholine, the anesthesiologist encounters difficulty with intubation. Bag-mask ventilation is adequate. After 3 failed intubation attempts, the patient's SpO₂ drops to 88%. Which of the following is the most appropriate next step?

A 28-year-old male with a history of difficult intubation (Cormack–Lehane Grade 3 at last anesthesia) presents for elective laparoscopic cholecystectomy. During rapid sequence intubation under general anesthesia, after induction with propofol and succinylcholine, the anesthesiologist attempts direct laryngoscopy and obtains a Grade 3 view. A second attempt with a different blade angle yields Grade 2 view. After two failed intubation attempts, the patient's oxygen saturation drops to 88% despite bag-mask ventilation. Which is the MOST appropriate next step?