Clinical Assessment

It is essential that a clinical assessment is made to identify patients who:

• Have a ASA classification of unstable class III or class IV and above
• May be difficult to ventilate

This assessment should include a past medical history, drug history and focussed clinical examination to identify any existing medical illnesses, particularly cardiovascular or respiratory disease and allergy.

Clinical assessment

Prior to performing procedural sedation the patient must undergo a focused clinical assessment.

A specific assessment of the airway should be made and the presence of any anatomic features that may affect airway management should be noted.

The LEMON mnemonic is a useful tool for assessing the airway and predicting difficult intubation. It includes the following components:

• Look externally: Assess the patient’s facial structure and any potential abnormalities.
• Evaluate 3-3-2 rule: Measure the distance between the patient’s mouth, hyoid bone, and thyroid notch.
• Mallampati score: Classify the visibility of the oropharyngeal structures.
• Obstructed airway: Check for any signs of obstruction.
• Neck mobility: Assess the range of motion in the neck.

Airway management

The presence of any anatomic features that may affect airway management should be noted carefully. [3]

Sedation of patients with an increased risk of adverse events requires a greater level of experience and training. Consider the urgency of the situation and whether a general anaesthetic delivered in an anaesthetic room is more appropriate.

Practitioners should always ask themselves beforehand: Will I be able to ventilate this patient, if necessary? [2]