Lecture Title: Lecture Title: Airway Evaluation and Management

Lecturer name:Lecturer name:

Lecture Date:Lecture Date:

Lecture Objectives..Lecture Objectives..

Students at the end of the lecture will be able to:

1. Learn about basic airway anatomy2. Conduct a preoperative airway assessment3. Identify a potentially difficult airway4. Understand the issues around aspiration and its prevention5. Learn about the management of airway obstruction6. Become familiar with airway equipment7. Practice airway management skills including bag and mask ventilation,

laryngeal mask insertion, endotracheal intubation8. Learn about controlled ventilation and become familiar with ventilatory

parameters9. Appreciate the different ways of monitoring oxygenation and ventilation

Indications of intubation

• Resuscitation (CPR)• Prevention of lung soiling• Positive pressure ventilation (GA)• Pulmonary toilet• Patent airway (coma or near coma)• Respiratory failure(CO2 retention )

Requirement of successful intbatin

• 1-Normal roomy mandible

• 2-Normal T-M, A-O , and C-spine

Requirements of successful intubation

3-Alignment of 3 axes orAssuming sniffing position

-Any anomaly in these 3 jointsA-O, T-M or C-spine can resultIn difficult intubation

Requirement of successful intubation

Proper equipment-Bag and mask,oxygen source-Airways oro and nasopharyngeal-Laryngosopes different blades-ETT different sizes-suction on

Airway gadgets

Management

I-History: previous history of difficulty is the best

predictorInquire about:-Nature of difficulty -No of trials -Ability to ventilate bet trials -Maneuver used -ComplicationsII-Snoring and sleep apnea( prdictors of DMV)

Examination

-Look for any obvious anomaly Morbid obesity(BMI) Skull Face Jaw Mouth,teeth Neck

Examination

I-The 3 joints movements A-O joint(15-20 degrees)Presence of a gap bet the Occiput and C1 is essential The cervical spine(range>90) T.M joint:-interdental gap(3 fingers) -subluxation (1 finger)

Examination

II-Measurements of the mandible-Thyro-mental distance (head extended)Normally 6.5 cmLess than 6 cm=expect difficulty

Tests to predict difficulty

Mallampatti test:Based on the hypothesisThat when the base of theTongue is disproportionallyLarge it will overshadow thelarynx

-Simple easy test,correlates with what is seen during laryngoscopy or Cormack-Lehene grades ,but

1-moderate sensitivity and specificity(12% false +ve)2-Inter observer variation3-Phonation increases false negative view

II-Wilson test

-Consists of 5 easily assessed factors Body wight(n=0 ,>90=1,>110=2) Head and neck movement Jaw movement Receding jaw Buck teethEach factor assigned as o ,1 ,2 max is 10

Difficult airway

• Expected from history,examinationSecure airway while awake under LA

Unexpected different optionsPriority for maintenance of patent airway and

oxygenation

Airway gadgets

Needle cricothyroidotomy

Confirm tube position

• Direct visualization of ETT between cords• Bronchoscopy ;carina seen• Continuous trace of capnography• 3 point auscultation• Esophageal detector device• Other as bilateral chest movement,mist in the

tube,CXR

Rapid sequence induction

• Indications• Technique: -Preoxygenation -IV induction with sux -Cricoid pressure -Intubate, inflate the cuff ,confirm position -Release cricoid and fix the tube

Complications of intubation

1-Inadequate ventilation2-Esophageal intubation3-Airway obstruction4-Bronchospasm5-Aspiration6- Trauma7-Stress response

Recommendations

• Adequate airway assessment to pick up expected D.A to be secured awake

• Difficult intubation cart always ready• Pre oxygenation as a routine

• Maintenance of oxygenation not the intubation should be your aim

• Use the technique you are familiar with• Always have plan B,C,D in unexpected D.A

Reference book and the Reference book and the relevant page numbers..relevant page numbers..

DrDr..

Date: Date:

TThank You hank You