*5.1.2.1.2 Mallampati classifications*

The Mallampati Classification is extremely useful in detection of potential obstructive sleep apnea as well as predictions of difficult endotracheal intubation,

**Figure 1.** *ULBT.*

**Figure 2.** *Mallampati score [4].*

The mallampati score is based on the visibility of the pharyngeal structures with maximal mouth opening and tongue protrusion in the setting position (**Table 2**, **Figure 2**).

#### *5.1.3 Laboratory investigations*

If the history and clinical examination fail to detect any abnormalities, routine investigations for healthy asymptomatic patients is not recommended as it increases the cost, delay the procedure and rarely changes the perioperative management. Therefore, investigations should be obtained only for specific clinical indication and for patients in whom the abnormality may be expected.

Pregnancy test may be considered for fertile women to avoid potential teratogenic effect for sedative agents on fetus in case of undiagnosed pregnancy.

#### *5.1.4 ASA physical status classification*

A re-evaluation of health status shortly before sedation and surgery is advised if the patient has been seen at an earlier appointment. The evaluation should be performed in accordance with the Physical Status Classification Scheme of the American Society of Anesthesiologists (ASA) (**Table 3**) [7]. Although the ASA classification is used by anesthesia and sedation suppliers to denote the overall preoperative status of a patient for anesthesia and sedation, a risk prediction cluster can be confused. It is necessary to note that this is not a classification of risk, but rather a clinical status assessment. For sedation outside the operating room, only patients in ASA Class I and II should be considered. ASA Class III, IV or V patients need higher levels of supervision and treatment. These patients are recommended to be carried out in-hospital.

#### **5.2 Categories of patients that need special treatment include**

#### *5.2.1 Obese patient*

Sedating the obese patients, especially out of hospital setting where the resources are limited is challenging to all sedative practitioners. Clinical assessment of functional capacity and myocardial functions of obese patient is not reliable due to sedentary life style and restricted physical activities. In addition, most of the obese patients suffer from chronic diseases such as diabetes mellites, hypertension, obstructive sleep apnea, and pulmonary hypertension which make

