Date of Award

Spring 4-28-2024

Document Type


Degree Name

Doctor of Nursing Practice (DNP)




Dr. Kacy Ballard CRNA, DNP

First Committee Member

Dr. Joy Shoemaker DNP, RN, APRN.CNP, FNP-C, CNE

Second Committee Member

Dr. Amy Bishop DNP, AGCNS


anesthesia, airway assessment, LEMON law, difficult airway

Subject Categories

Medicine and Health Sciences


Managing the airway is the cornerstone of anesthesia care. However, difficult airway or intubation is not clearly defined. A major complication with a difficult airway is a cannot intubate, cannot ventilate (CICV) situation, which is reported to be as high as 10%. In addition, according to the American Society of Anesthesiologists (ASA) Closed Claim Study, "Adverse respiratory events are the most common type of injury, with difficult intubation [DI] and ventilation contributing to most of the cases. Twenty-eight percent of all anesthesia deaths are related to a CICV situation. As anesthesia evolves, basic airway assessments were developed and include mallampati (MP), thyromental distance (TMD), upper lip bite test (ULBT), and interincisor distance (IID). However, not one basic airway assessment accurately predicts a DI.

The problem is inappropriate or inadequate airway management because a difficult airway can lead to an emergency, such as an anoxic brain injury, respiratory compromise, or even cardiac arrest. The DNP project aims to implement a standardized guideline for the preoperative assessment tool, the LEMON law, as the standard of care for preoperative airway assessment in patients undergoing surgical operations requiring endotracheal tube (ETT) intubation. Theoretical implementation plan at a medical center in the Midwest utilizing a direct supervision anesthesia model to enact the Plan-Do-Check-Act (PDCA) model to evaluate the effectiveness and outcomes relating to the prediction of difficult airway, the prevalence of hypoxia, and effect on patients.

Keywords: anesthesia, airway assessment, LEMON law, difficult airway

Acknowledgement 1


Acknowledgement 2


Licensing Permission

Copyright, all rights reserved. Fair Use



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