British journal of anaesthesia
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The applied anatomy of the cricothyroid and cricotracheal region of the neck and a retrograde method of tracheal intubation using the subcricoid region are described. This approach has several advantages, including absence of bleeding complications, as there are no major blood vessels on the cricotracheal membrane, and reduction in the possible development of subglottic oedema and stenosis.
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We have studied the effects of phonation and posture on the Mallampati classification of view of the pharyngeal structures. Differences between observers were allowed for by the experimental design and log-linear modelling. Sixty-four patients were assessed on the ward, sitting upright, with and without phonation, by each of two observers. ⋯ Differences between observers were non-systematic but substantial. About 25% of patients phonated spontaneously. It is recommended that anaesthetists make their own assessments of Mallampati classification, with the patient in either of the postures but always either with or without phonation, and thereby gradually "calibrate" their assessments against the degree of difficulty encountered in intubation.