Wang et al listed a number of risk factors associated with a difficult or complicated intubation. The identification of one or more risk factors can help identify a patient who may require additional care during the intubation. The authors are from the University of Pittsburgh and Geisinger Health System (Danville, Pennsylvania).


Risk factors in the oropharynx:

(1) large tongue

(2) small mouth

(3) overbite

(4) dental trauma

(5) clenched jaw or trismus

(6) intact gag reflex


Risk factors affecting the neck and muscles:

(1) inadequate muscular relaxation

(2) poor neck flexibility

(3) short and/or fat neck


Risk factors associated with the vocal cords and/or larynx:

(1) inability to pass an endotracheal tube through the vocal cords

(2) inability to visualize the vocal cords

(3) anterior vocal cords

(4) laryngospasm


Problems occupying or obscurring the airway

(1) epistaxis

(2) vomiting

(3) foreign body or trauma to the airway


Problems during the intubation attempt:

(1) hypoxemia or desaturation (< 90%) during the intubation attempt

(2) bradycardia during the intubation attempt

(3) equipment failure

(4) combative behavior by the patient


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