Airway Passport
Difficult airway letter generator
Date of anaesthetic:
Hospital:
Patient Name:
Hospital record number:
Clinician's Name
Assessment
Induction
Mask Ventilation
Supraglottic airway
Direct laryngoscopy
Video laryngoscopy
Awake Fibreoptic Intubation (pend)
Endotracheal tube
Notes/Recommendations
Generate letter
Airway Passport
Assessment
BMI
<25
25-30
30-40
40-50
>50
Malampatti
1
2
3
4
Thyromental Dist (cm)
<6
>6
Mouth opening
>5cm
4-5cm
2-4cm
<2cm
Dentition
Own teeth
Partial upper
Partial lower
Partial lower + upper
No teeth
Facial hair
Beard
No beard
Neck extension
Normal
Limited
Immobile
Jaw protrusion
Cannot protrude lower teeth past upper teeth
Can protrude lower teeth past upper teeth
Medical issues
OSA
Diabetes
Rheumatoid arthritis
Neck radiotherapy
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Airway Passport
Induction
Induction
Awake
Intravenous
Intravenous/RSI
Inhalational
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Airway Passport
Mask ventilation
Difficulty (Han's grading scale)
1.Easy
2.Adjunct required
3.Hard (two handed)
4.Unable to mask ventilate
Adjuncts
No adjuncts
Guedel
Nasopharyngeal airway (NPA)
Guedel + NPA
Muscle relaxant
Yes
No
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Airway Passport
Supraglottic airway 1
Type
LMA Classic
LMA Supreme
LMA Proseal
LMA Fastrac
Size
1.5
2
2.5
3
4
5
Seal
Good seal
Partial seal
Inadequate seal
Muscle relaxant
Yes
No
Success
Fail
Supraglottic airway 2
Type
LMA Classic
LMA Supreme
LMA Proseal
LMA Fastrac
Size
1.5
2
2.5
3
4
5
Seal
Good
Partial
None
Muscle relaxant
Yes
No
Success
Fail
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Airway Passport
Direct Laryngoscopy
Grade (Cormack and Lehane, modified)
Grade I
Grade IIa
Grade IIb
Grade IIIa
Grade IIIb
Grade IV
Blade
Miller
Macintosh
Seward
McCoy
Kessel
Blade size
0
1
2
3
4
Laryngeal manipulation
None
Mild
Moderate
Maximal
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Airway Passport
Video Laryngoscopy
Brand
Glidescope reusable
Glidescope disposable
C-MAC reusable
C-MAC disposable
McGrath
Blade type
Blade type
Miller
Macintosh
D-Blade
LoPro
Blade size
0
1
2
3
4
Grade (Video grading)
Grade I V
Grade IIa V
Grade IIb V
Grade IIIa V
Grade IIIb V
Grade IV V
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Airway Passport
Awake Fibreoptic Intubation
Position
Sitting
Supine
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Airway Passport
Endotracheal tube
ETT Route
Oral
Nasal
ETT Type
Cuffed ETT
Uncuffed ETT
Microcuff ETT
Microlaryngoscopy ETT
Reinforced ETT
Fastrac ETT
ETT Size
2
2.5
3
3.5
4
4.5
5
5.5
6
6.5
7
7.5
8
8.5
9
Insertion Adjunct
Bougie
Flextip Bougie
Stylet
Cook Catheter
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Airway Passport
Notes/Recommendations
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Airway Passport
Difficult airway letter
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