airway management anaesthesia instruments.pptx

Airway mnagement

1. Airway management Intern Dr.susmita Gupta

2. Content Aim Anatomy Assessment of airway Management of airway

3. Anatomy Airway is divided into – Upper airway – nose , oral cavity , pharynx , larynx Lower airway – trachea ,bronchus , respiratory bronchioles ,terminal bronchioles and alveoli

4. Cont ….

5. Aim To maintain patent airway

6. Causes of airway obstruction Inability to open mouth –submandibular abscess , temporomandibular joint ankylosis Mandible- micrognathia , pierr robin syndrome Tongue – macroglossia Soft palate – high arched palate Neck abnormalities- short neck , restricted neck movement, trauma , contracture , diabetes mellitus Larynx – edema , tumor Trachea – stenosis Thoracoabdominal –kyphosis Others – protruding teeth , absent denture

7. Assessment of airway It can be done by preanesthetic check up (PAC) Mouth opening >2 fingers Thyromental distance >6.5 cm or >3 fingers Neck movement –between 165° and 90° Temporomandibular joint function – inter incisor gap (mouth opening) at least 5cm or 2 fingers breadth Loose teeth or false teeth Mallampati grading -

8. Diagram of mallampati

9. Cotmack and lehane

10. Investigation Chest and cervical x-ray Pulmonary function test

11. Preanesthetic preparation Machines and monitor checked Monitors – capnography , pulse oximeter, oxygen analyser , spirometer, airway pressure monitor Alarms, ventilator, storage drawer, suction port, auxillary oxygen source, provision for closed and semiclosed circuit, scavenging system, electric plug

12. Cont.. Different pressure system – High Int

13. Anesthesia work station

14. Equipments Guedels oropharyngeal airway Facemask AMBU bag Laryngoscope Laryngeal mask airway Endotracheal tube

15. Face mask and ambu bag

16. Oxygen delivery in non –intubated patient High flow system Low flow system

17. Extracorporeal oxygen delivery system Bubble oxygenator Membrane oxygenator

18. Humidification devices Humidifiers – Passive humidifier Active humidifier – Non – heated humidifier Heated humidifier

19. Method of airway management Basic airway management Advanced airway management

20. Basic airway management

21. Advanced airway management Oropharyngeal and nasopharyngeal airway Endotracheal intubation Laryngeal mask airway Cricothyroidectomy Tracheostomy

22. Oropharyngeal airway Indication Failure to oxygenate with mask Prolonged ventilation required Complication ………….

23. Cont …

24. Size of endotracheal tube Premature :2.5 0-6 months : 3-3.5 6month to 1 year : 3.5-4 For children 1 year to 6 year, the size is calculated by formula : age in years /3 +3.5 For children >6 years age in years /4+4.5

25. Cont …. Normal healthy male : 7-7.5 Normal healthy female : 7.5-8.5 Length of tube Age in years /2+12 cm

26. Procedure Hold the laryngoscope with left hand irrespective of dominant hand Open the mouth with right hand with support of thumb Introduce the laryngoscope with right angle of mouth Shift the tongue towards left and go in Press over tongue See epiglottis and Lift it Watch for vocal cord

27. Laryngeal mask airway Indication As an alternative to intubation where intubation is anticipated

28. Laryngeal mask airway Indication As an alternative to intubation where difficult intubation is anticipated Securing airway in emergency situation where intubation and mask ventilation becomes impossible As an elective method for minor to moderate surgeries where anesthetist wants to avoid intubation As a conduit for bronchoscope, small size tubes and gum elastic bougies

29. Cont …. Advantage Easy insert No laryngoscope and muscle relaxant No specific position Less sympathetic stimulation Awaking smooth, reusable

30. Cont … Disadvantage Air leak in stomach Trauma to oral cavity and hypoglossal and lingual nerve Laryngospasm and airway obstruction Sore throat Contraindication Full stomach, hiatus hernia, pregnancy, oropharyngeal abscess or mass

31. Cont ….

32. Size of LMA

33. Procedure – neck flexed and head extended Use non inserting head to stabilize the occiput Jaw should be pulled down by assistant Lma tube be grapsed like a pen with index finger pressing the point where tube join mask Place the tip of the lma against the inner surface of the patient upper teeth Aperture facing forward, the tip pressed upward against hard palate Mask is advanced into pharynx to ensure that tip remains flattened and avoid the tongue

34. Cont …

35. Extubation Performed when patient is deeply anesthesied Spontaneously breathing and awake Suctioning of oral cavity done Deflate the tube in single smooth motion Face mask should be applied

36. Complication Esophageal intubation Teeth damage Trauma to oral cavity Intubation in single lung Tube displacement Tube obstruction Laryngospasm