Airway management
Introduction
1.What is airway?
It's the normal passage way for air entry/exit in human for good gas exchange @ the lungs
It includes nose/mouth, pharynx, larynx and trachea
2.Steps of airway management
2.1. Assessment(What to assess?)
a) Assessment of airway patency
b) assessment of airway protection
2.2. Intervention
a) General guidelines
b)Simple maneuvers and airway adjunct devices
Methods of assessment
1.History taking(AP3CD/TS)
Age
Previous neck surgery
- Tracheostomy, thyroidectomy
Previous airway problems
- difficult intibations, stenosis, reaction to anaesthesia
Previous Hemi-mandibulectomy
Crvical spine abnormalities
- Cervical spondylosis or ankylosing spondylosis
Dentures or loose teeth
Tmporo-mandibular joint (TMJ) dysfunction
Snoring or sleep apnea
2.Physical examination
(From above downward)
Face/Teeth,tongue/mandibule/neck
Face (Any facial deformities) :
- Receding chin
- Smal SM space
Teeth:
- Malocclusion overbite of anterior teeth
Tongue:
- Large tongue
Mandibule:
- Limited protrusion of mandibule
- Limited opening of mouth
Neck(SOLD):
- Short neck
- Obesity
- Limited neck movement
- DOorso-cervical fat pad
3.Tests used in assessment
a) Oropharynx
Mallapati score
b) Atlanto-occipital joint
H&N extension
(Normally 35ْ )
c) SM spaces
Thyro-mental space
(Normally More than 6.5cm/3fingers)
if less than 6cm => considered difficult intubation
The blade used during laryngeoscope is called
Miller-blade
Sterno-mental space
Critical distance is 12.5cm
d) Other spaces
Inter-incisor distance
(Normally 3 fingers)
Hyoid to mental distance
(Normally 3 fingers)
Thyroid to hyoid distance
(Normally 2 fingers)
Tools used in management/intervention
(Artificial airway)
Face mask
Oropharyngeal airway (OPA)
Supraglottic airway devices
☻Laryngeal mask airway (LMA) family (PF2UC2)
LMA Proseal
LMA flexible
LMA fastrach
LMA unique
LMA Classic
LMA Ctrach
☻Other supraglottic airways similar to LMA (SAI)
Soft seal LM
Ambu laryngeal mask
Intubating laryngeal airway
☻Others (PLS!)
Perilaryngeal airway
Laryngeal tube airway
Streamlined pharynx airway liner
Infraglottic airway devices
Supraglottic access
Endotracheal tube (ETT)
Fiber optic devices
Infraglottic acess (CTR)
Cricothyroidotomy
Tracheostomy
Retrograde intubation