AIRWAY MANAGEMENT

DR. AZHAR MOHAMED ANAESTHESIA DEPARTMENT HTAA , KUANTAN

What should we know about airway management?

- Maintenance and ventilation - Intubation and extubation - Difficult airway management

Airway anatomy and function Evaluation of airway Clinical management of the airway

Evaluation of the airway

History Previous history of difficult airway Airway-related untoward events Airway-related symptoms/diseases

AIRWAY ASSESSMENT

Difficulties in Airway Management micrognathia macroglossia acromegaly

Physical Limitation temporal/mandibular fractures arthritis burns scarring tumor infection with masseter muscle induration

Potential Airway Obstruction inability to articulate clearly dysphagia stridor Inability to Swallow or Manage Secretions drooling

Pain Mediated Limitation Trismus (masseter spasm)

Dentition loose, missing, or chipped teeth, Buck teeth Foreign bodies dental appliances chewing gum dislodged teeth food

Tongue shape, size, mobility orophayngeal opening Posterior pharyngeal wall hematomas infections retropharyngeal abscesses

Samsoon's Modification of Mallampati's Airway Classes

To classify a patient into populations with varying difficulties of intubation The oral cavity is examined with the patient seated upright, head in neutral position, mouth opened as wide as possible, and tongue protruded maximally

Class I: soft palate, tonsillar fauces, tonsillar pillars, uvual visualized - "easy" intubation Class II: soft palate, tonsillar fauces, uvual visualized - "mildly difficult" intubation Class III: soft palate, base of uvula visualized - "much more difficult" intubation Class IV: soft palate not visible - "near impossible" intubation

HEAD TILT & JAW THRUST

head tilt - chin lift maneuver The jaw thrust is another method for clearing the tongue from the airway

sniff position

AIRWAY INSTRUMENTS

various types of masks

LARYNGOSCOPE

ORAL AIRWAY

Design to keep the tongue from falling back and blocking the upper airway Only used in unresponsive patient with no gag reflex Corner of patients mouth to the angle of jaw

NASOPHARYNGEAL AIRWAY

Curved, flexible rubber @ plastic tubes inserted into patientss nostrils Use on responsive patient in need of airway assist Tip of patients nose to the earlobe Diameter should fit patients nostril without excessive tightness

should be avoided in patients with: evidence of fracture of middle third of face. cerebro-spinal fluid leaks. vascular abnormalities of nose. bleeding disorders. sepsis in the nose. trauma to the nose.

AIRWAYS ADJUNCTS

Fibreoptic intubations
Require good skills Awake or GA Indications
Anticipated difficult airway Unable to ventilate patient

THANK YOU