Modified Mallampati Classification
Stratifies predicted difficulty of endotracheal intubation based on anatomic features.
Position patient seated upright and direct patient to open mouth and protrude tongue fully.
Advice
Consider strategies to improve ease of intubation in patients with a predicted difficult airway (class III-IV), e.g. video-assisted laryngoscopy, awake intubation.
Management
For airways anticipated or identified to be difficult, consider involving other airway specialists early, and identify alternatives to endotracheal intubation such as laryngeal mask airway, bougie-guided intubation, or other adjuncts.
Critical Actions
In any intubation, especially in an emergency setting, determine the “Plan B” and “Plan C” if initial attempts fail before starting the procedure, whenever possible.