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8/4/2019 Airway Management 1
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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