CASE REPORT ventilation or intubation. The airway was secured with a 7.5 mm (ID) endotracheal tube without use of aided device for difficult airway management. Anesthesia was maintained with oxygen, air, and isoflurane. Surgery lasted for 3 hours and was uneventful. Patients trachea was extubated successfully and she was shifted to postoperative ward. D ISCUSSION The probability of difficult mask ventilation has been estimated to be 2.7% and of difficult mask ventilation with difficult laryngoscopy to be 1.69%. 3 Among the various predictors of difficult airway, Mallampati score remains the most commonly used. It is a graded 4-level pictorial scale created to predict difficult intubation before general anesthesia and is routinely used in operating room worldwide. 4 This score has been extrapolated outside of the operating room to procedural sedation, with a number of specialty societies recommending it as a routine screening element. Painful mouth opening during preoperative airway examination affects the difficult airway predictors and gives a false impression of restricted airway. Difficult airway predictor applied in case of I NTRODUCTION Careful preoperative evaluation and planning is essential to prevent airway related morbidity and mortality during induction of anesthesia. 1 Difficult airway (DA) has been defined as ˝the clinical situation in which a conventionally trained anaesthesiologist experiences difficulty in face mask ventilation of the upper airway, difficulty in tracheal intubation, or both.˝ 2 Predictors of difficult airway include Mallampati III, limitation of jaw protrusion, male sex, presence of teeth, limited neck extension, and reduced thyromental distance. Here we describe a case of painful mouth opening in which preoperative airway assessment was facilitated using analgesics (fentanyl 2 mcg/kg). This case report has been prepared in accordance with CARE guideline. Written and informed consent for publication was obtained from the patient. C ASE D ESCRIPTION A 70-year-old female, BMI= 23 kg/m 2 was scheduled for open surgical debridement of right-sided rhinocerebral mucormycosis. She had been diagnosed with COVID-19, 6 weeks back for which she was put on steroids. Though she had recovered from COVID, she had developed rhinocerebral mucormycosis, for which she was undergoing treatment (10 mg/kg/day for the last 2 weeks). On examination, the airway examination revealed restricted mouth opening: (1 Finger Breadth) which led to a higher grading of Mallampati score (MP IV). The other parameters were: thyromental distance (thyroid incision distance more than 4.5 cm), normal neck extension, and mandibular elevation (upper lip bite test I degree). Fentanyl (2 mcg/kg) was given to relieve the muscle spasm which increased to mouth opening to 2.5 finger breadth. Mallampati grading improved to II thereafter. After shifting the patient to operating room, standard ASA monitors were attached and base line vitals noted. An intravenous line was secured and infusion of balanced salt solution was started as maintenance fluid. Anestheia was induced with injection propofol 2 mg/kg and vecuronium 0.1 mg/kg. There was no difficulty in mask 1 Department of Trauma & Emergency, All India Institute of Medical Sciences, Patna, Bihar, India 2–6 Department of Anaesthesiology, All India Institute of Medical Sciences, Patna, Bihar, India Corresponding Author: Chandni Sinha, Department of Anaesthesiology, All India Institute of Medical Sciences, Patna, Bihar, India, Phone: +91 7250333148, e-mail: chandni.doc@gmail.com How to cite this article: Kumar A, Sinha C, Kumar A, et al. Role for Pre-emptive Analgesia to Increase the Accuracy of Airway Assessment in Patients having Painful Mouth Opening: A Case Report. J Res and Innov Anesth 2022;7(1):25–26. Source of support: Nil Conflict of interest: None Role for Pre-emptive Analgesia to Increase the Accuracy of Airway Assessment in Patients having Painful Mouth Opening: A Case Report Amarjeet Kumar 1 , Chandni Sinha 2 , Ajeet Kumar 3 , Poonam Kumari 4 , Kritika Singh 5 , Gayatri D Sagdeo 6 A BSTRACT Careful preoperative evaluation and planning is essential to prevent airway-related morbidity and mortality during induction of anesthesia. According to previous studies, predictors of difficult airway include Mallampati III, limitation of jaw protrusion, male sex, presence of teeth, limited neck extension, and reduced thyromental distance. There are no clear-cut guidelines regarding application of difficult airway predictors in patient having painful mouth opening. In this case report, we have described our experience of pre-emptive analgesia to increase the accuracy of airway assessment in patient having painful mouth opening. Keywords: Airway management, Analgesia, Fentanyl, Mucormycosis. Journal of Research and Innovation in Anesthesia (2022): 10.5005/jp-journals-10049-2004 © The Author(s). 2022 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons. org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.