Anesthesia and Reanimation: AIRWAY and ENTUBATION.pptx

This is a ppt from İstanbul Aydin Üniversitesi for Medicine (english) Third year students

1. AIRWAY and ENTUBATION Dr. Feryal Akşan Anesthesiology and Reanimation ‹#›

2. Assessment of the Airway Preparation and Equipment Patient Positioning Bag-Valve-Mask Ventilation Intubation ‹#›

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4. Mallampati Scoring In anesthesiology, the Mallampati score is used to estimate the ease of endotracheal intubation. It involves a visual assessment of the distance from the base of the tongue to the palate. ‹#›

5. Mallampati Scoring Class I: Uvula, soft palate, tonsillar pillar, both anterior and posterior arches can be easily seen. Class II: Uvula and soft palate are visible. Class III: Only the base of the uvula and soft palate can be seen. Class IV: Uvula is completely obscured by the base of the tongue, and the pharyngeal wall is not visible . ‹#›

6. Cormack & Lehane Laryngoscopic View The Cormack-Lehane system classifies images obtained with direct laryngoscopy according to the structures seen. ‹#›

7. Cormack & Lehane Laryngoscopic View Grade I: Full view of the glottic opening. Grade II: Anterior glottic opening not visible. Grade III: Epiglottis visible, but the glottic opening is not visible. Grade IV: Epiglottis not visible. ‹#›

8. Thyromental Distance: 4-7 cm Indicates how much the tongue can be displaced during laryngoscopy. Sternomental Distance: 12,5-13,5 cm Head and neck movement. The extension of the head is the most important factor in determining the ease or difficulty of intubation. Mouth Opening: >3 cm ‹#› Assessment of the Airway

9. EQUIPMENT Oxygen Source Capacity for Bag-Valve-Mask Ventilation Laryngoscope (Direct and Video) Endotracheal Tubes of Various Sizes Other Airway Devices (besides ETT) Suction Device Oximeter and CO2 Detection Stethoscope ‹#›

10. Koh KF. Clinical update on managing the obstructed airway. Ann Acad Med Singap. 2002 Mar;31(2):253-6. PMID: 11957570. Loss of muscle tone in the upper airway can cause the tongue and epiglottis to fall against the posterior wall of the pharynx. ‹#›

11. Before intubation, patients are often fitted with an "airway management device" to keep the airway open. The most common of these devices include: Oral Airway: A device inserted into the patient's mouth to prevent the tongue from blocking the airway. Nasopharyngeal Airway (Nasal Airway): A tube inserted into the nostril to keep the airway open, especially useful when an oral airway cannot be used. Laryngeal Mask Airway (LMA): Placed in the throat over the larynx, this acts as a mask to maintain an open airway, useful during intubation or other procedures. ‹#›

12. This airway is placed into oral cavity to ease the ventilation with mask ‹#› Oral Airway:

13. Should be used with caution in patients on anticoagulants. In patients with thrombocytopenia. Must be carefully used in patients with basilar skull fractures. ‹#› Nasopharyngeal Airway (Nasal Airway):

14. Laryngeal Mask Airway (LMA): Indicated in cases of pharyngeal obstruction or pathologies. In patients with a risk of aspiration. May be a relative contraindication in patients requiring more than 30 cmH2O peak inspiratory pressure due to low pulmonary compliance. ‹#›

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17. Transparent masks allow for the observation of moist exhalation gases and the immediate detection of vomiting. ‹#› Bag-Valve-Mask Ventilation

18. You can see the application of transparent mask ‹#›

19. head extension chin thrust Opening the airway be proper positioning ‹#› Patient Positioning

20. FR C H ead and upper back is elevated, t o increase the Functional Residual Capacity. ‹#›

21. PREOXYGENATION Preoxygenation should be performed prior to airway interventions if possible. It fills nearly 90% of the Functional Residual Capacity (FRC) with oxygen. Provides a 5-8 minute oxygen reserve. Increases the safety duration of apnea without desaturation. In conditions where oxygen needs increase (such as sepsis, pregnancy) and FRC decreases (like in morbid obesity, pregnancy), preoxygenation shortens the period of apnea without desaturation. ‹#›

22. When Should Intubation Be Performed? Inadequate Oxygenation: Failure to increase saturation above 90% despite optimal oxygenation. Inadequate Ventilation: Presence of tachypnea, Abnormal depth or effort in breathing, Use of accessory muscles, Inability to speak in full sentences, Abnormal breath sounds (like stridor or severe wheezing), Altered level of consciousness. ‹#›

23. It is accepted that patients with a Glasgow Coma Score (GCS) ≤ 8 cannot protect their airway. Gag reflex stimulation can lead to undesirable outcomes in patients with impaired consciousness or trauma patients (such as gagging, coughing, or vomiting). Additionally, one-third of healthy individuals may not have a gag reflex. It is accepted that a patient who can swallow spontaneously in a supine position can protect their airway. Airway Protection ‹#›

24. Visualisation of intubation ‹#› Laryngoscopy:

25. Laryngoscopy: ‹#› Carefully insert the laryngoscope into the patient's mouth. Advance alongside the tongue to visualize the epiglottis and the glottic opening. Videolaryngoscopy

26. Visualisation of intubation ‹#›

27. Placement of the Endotracheal Tube: While maintaining your view with the laryngoscope, guide the endotracheal tube into the trachea. Ensure that the tube is correctly positioned within the trachea and not inserted into the bronchi. ‹#›

28. Confirmation of Correct Tube Placement: Verify the correct placement of the tube by observing chest movements, auscultation (listening with a stethoscope), and monitoring end-tidal CO2 (etCO2). Securing the Tube: Secure the endotracheal tube and connect it to the ventilator using the connecting adapter. Final Checks: Continuously monitor and make necessary adjustments to ensure that the tube remains in place and does not dislodge. ‹#›

29. Endotracheal intubation ‹#›

30. Thanks for listening… ‹#›