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AIRWAY MANAGEMENT

DR. AZHAR MOHAMEDDR. AZHAR MOHAMED

ANAESTHESIA DEPARTMENTANAESTHESIA DEPARTMENTHTAA , KUANTANHTAA , KUANTAN

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What should we know aboutairway management?

- Maintenance and ventilation

- Intubation and extubation

- Difficult airway management

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Airway anatomy and function

Evaluation of airway

Clinical management of the airway

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Evaluation of the airway

History

Previous history of difficult airway

Airway-related untoward events

Airway-related symptoms/diseases

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AIRWAY ASSESSMENT

Difficulties in Airway ManagementDifficulties in Airway Management

micrognathiamicrognathia

macroglossiamacroglossia

acromegalyacromegaly

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Physical LimitationPhysical Limitation

temporal/mandibulartemporal/mandibular

fracturesfractures

arthritisarthritis

burnsburns

scarringscarring

tumortumor infection with masseterinfection with masseter

muscle indurationmuscle induration

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Potential AirwayPotential AirwayObstructionObstruction

inability toinability toarticulate clearlyarticulate clearly

dysphagiadysphagia stridorstridor

Inability to Swallow orInability to Swallow orManage SecretionsManage Secretions droolingdrooling

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Pain Mediated LimitationPain Mediated Limitation

Trismus (masseter spasm)Trismus (masseter spasm)

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DentitionDentition

loose, missing, or chipped teeth, Buckloose, missing, or chipped teeth, Buckteethteeth

Foreign bodiesForeign bodies

dental appliancesdental appliances chewing gumchewing gum

dislodged teethdislodged teeth

foodfood

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TongueTongue

shape, size, mobilityshape, size, mobility

orophayngeal openingorophayngeal opening Posterior pharyngeal wallPosterior pharyngeal wall

hematomashematomas

infectionsinfections retropharyngealretropharyngeal

abscessesabscesses

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Samsoon's Modification of

Mallampati's Airway Classes

To classify a patient into populations withTo classify a patient into populations with

varying difficulties of intubationvarying difficulties of intubation

The oral cavity is examined with the patientThe oral cavity is examined with the patientseated upright, head in neutral position,seated upright, head in neutral position,

mouth opened as wide as possible, andmouth opened as wide as possible, and

tongue protruded maximallytongue protruded maximally

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Class I:Class I: soft palate, tonsillar fauces,soft palate, tonsillar fauces,

tonsillar pillars, uvual visualized -tonsillar pillars, uvual visualized - "easy""easy"intubationintubation

Class II:Class II: soft palate, tonsillar fauces, uvualsoft palate, tonsillar fauces, uvual

visualized -visualized - "mildly difficult""mildly difficult" intubationintubation Class III:Class III: soft palate, base of uvulasoft palate, base of uvula

visualized -visualized - "much more difficult""much more difficult"intubationintubation

Class IV:Class IV: soft palate not visible -soft palate not visible - "near"nearimpossible"impossible" intubationintubation

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HEAD TILT & JAW THRUST

head tilt - chin lifthead tilt - chin lift

maneuvermaneuver

The jaw thrust isThe jaw thrust isanother methodanother method

for clearing thefor clearing the

tongue from thetongue from the

airwayairway

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sniff positionsniff position

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various types ofvarious types ofmasksmasks

AIRWAY INSTRUMENTS

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LARYNGOSCOPE

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ORAL AIRWAY

Design to keep theDesign to keep thetongue from fallingtongue from falling

back and blocking theback and blocking the

upper airwayupper airway Only used inOnly used in

unresponsive patientunresponsive patientwith no gag reflexwith no gag reflex

Corner of patientsCorner of patientsmouth to the angle ofmouth to the angle of

jawjaw

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NASOPHARYNGEAL

AIRWAY Curved, flexible rubber @Curved, flexible rubber @

plastic tubes inserted intoplastic tubes inserted into

patientss nostrilspatientss nostrils

Use on responsive patientUse on responsive patient

in need of airway assistin need of airway assist

Tip of patients nose to theTip of patients nose to the

earlobeearlobe

Diameter should fitDiameter should fit

patients nostril withoutpatients nostril without

excessive tightnessexcessive tightness

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should be avoided in patients with:should be avoided in patients with: evidence of fracture of middle third ofevidence of fracture of middle third of

face.face.

cerebro-spinal fluid leaks.cerebro-spinal fluid leaks.vascular abnormalities of nose.vascular abnormalities of nose.

bleeding disorders.bleeding disorders.

sepsis in the nose.sepsis in the nose.

trauma to the nose.trauma to the nose.

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AIRWAYS ADJUNCTS

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Fibreoptic intubationsRequire good skills

Awake or GA

Indications

Anticipated difficult airway

Unable to ventilate patient

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THANK YOUTHANK YOU