Difficult airway assessment and management
Sponsored Links
This presentation is the property of its rightful owner.
1 / 23

DIFFICULT AIRWAY ASSESSMENT AND MANAGEMENT PowerPoint PPT Presentation


  • 134 Views
  • Uploaded on
  • Presentation posted in: General

DIFFICULT AIRWAY ASSESSMENT AND MANAGEMENT. BY DR AZHAR. DEFFINATION. American society of Anesthesiologist (ASA) suggested that when sign of inadequate ventilation could not be reversed by mask ventilation or oxygen saturation could not be maintained above 90% or

Download Presentation

DIFFICULT AIRWAY ASSESSMENT AND MANAGEMENT

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


DIFFICULT AIRWAYASSESSMENT ANDMANAGEMENT

BY

DR AZHAR


DEFFINATION

American society of Anesthesiologist (ASA) suggested that when sign of inadequate ventilation could not be reversed by mask ventilation or oxygen saturation could not be maintained above 90% or

if a trained Anaesthetist usinig conventional larangoscope take’s more than 3 attempts or

more than 10 minute are required to complete tracheal intubation


Anatomy of oropharynex and larynx


PREVALENCE

Fact of the matter is even with proper evaluation only 15 to 50 % were picked up while difficult face mask ventilation in general is about 1:10,000 out of which again 15% proved to be the difficult intubation ,while incidence of extreme difficult or abandons intubation in general surgery patients are 1:2000 but in obstetrics is 1:300 and of course most critical incidence is Hypoxia


BASIC AIRWAY EVALUATION

  • Previous anaesthetic problems and general appearance of the patient.

  • Neck, face, maxilla and mandible with jaw movements.

  • Head extension and movements, teeth, oropharanx and soft tissue of the neck .


Why does it happens ?

  • Exaggerated idea of personal ability.

  • Not requesting for experienced help.

  • No discussion with colleagues about proposed management of the case .

  • Ill conceived plan (A) with no proper back up plan (B).

  • Even poorly conducted plan (A) or sticking extra time to the plan (A) other way delaying the rescue plan late.

  • Last not the least not involving surgical friends.


CAUSES OF DIFFICULT INTUBATION

Anaesthetist

  • Inadequate preoperative assessment.

  • Inadequate equipments.

  • Experience not enough.

  • Poor technique.

  • Malfunctioning of equipment.

  • Inexperience assistanance

    Patient

  • Congenital causes

  • Acquired causes


Anatomical factors affecting Larangoscopy

  • Short Neck.

  • Protruding incisor teeth.

  • Long high arched palate.

  • Poor mobility of neck.

  • Increase in either anterior depth or Posterior depth of the mandible decrease in Atlanto Occipital distance that's why role of Radiology has increased in our specialty


ASSESSMENT OF AIRWAY

Mallampati classification with larangoscopic view.

Patil’sTest


Measurement of Atlanto-Occepital Angle


MANAGEMENT PLAN OF ANTICEPATED DIFFICULT AIRWAY

  • Discussion with colleagues in advance.

  • Equipment tested before.

  • Senior help backup.

  • Definite initial plan (A) for ventilation and intubation.

  • Definite plan (B) than option of awake intubation.

  • Ideal situation surgery team standby.


UNEXPECTED DIFFICULT AIRWAY Problems

  • Unexpected encounter with difficult airway is mostly gone worse because mainly GA is already given including (NMB,S).

  • Equipment may not be in hand.

  • Senior and back up plan not available so delay occur in active resuscitation

    TECHNIQUE OF MANAGEMENT

  • Manipulation of the patients airway.

  • Laryngeal pressure.

  • Nasal or oral airway.

  • Different blades of larangoscope like Miller, Magill, Robershaw , Mackintosh and relatively new laryngoscope McCoy.

  • Bougies and stylet

  • LMA.

  • Combitube.


1

Manipulation of airway

different blade, bugie

2

LMA, ILMA, Combitube

3

Trantracheal Jet Ventilation

4

Cricothireotomy, Tracheostomy


GALLERY OF TOOLS


GALLERY OF TOOLS

Bullard laryngoscope Fiber optic


Mini Tracheostomy


Mini Tracheostomy (Cont.)


BLIND NASAL,RETROGRADE AND HIGH FREQUENCY VENTILATION


Awake Intubation


ASA ALLOGORYTHAM


ASA ALLGORYTHAM


C-SPINE OA


THANK YOU

VERY MUCH

FOR YOUR ATTENTION


  • Login