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AIRWAY MANAGEMENT When you can’t breath, nothing else matters Department of Anesthesiology Uniformed Services University of the Health Sciences Establishing A Patent Airway Chin Lift and Jaw Thrust Maneuver Oropharyngeal Airway Nasopharyngeal Airway Laryngeal Mask Airway

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airway management

AIRWAY MANAGEMENT

When you can’t breath, nothing else matters

Department of Anesthesiology

Uniformed Services University of the Health Sciences

establishing a patent airway
Establishing A Patent Airway
  • Chin Lift and Jaw Thrust Maneuver
  • Oropharyngeal Airway
  • Nasopharyngeal Airway
  • Laryngeal Mask Airway

- The above do not protect against aspiration and laryngospasm

Department of Anesthesiology

Uniformed Services University of the Health Sciences

mask ventilation
Mask Ventilation
  • Can Deliver A High FIO2
  • Avoids The Potential Trauma Of Intubation
  • Does Not Protect Against Aspiration
  • May Result In Gastric Distension
  • Laryngospasm Can Occur
  • Requires Use Of Both Hands

Department of Anesthesiology

Uniformed Services University of the Health Sciences

oral nasal intubation
Oral/Nasal Intubation
  • Safe and Common Practice in Patients Undergoing General Anesthesia
  • Atraumatic Intubation requires Knowledge of Anatomy, Appropriate use of Equipment, and Drugs (Muscle Relaxants)

Department of Anesthesiology

Uniformed Services University of the Health Sciences

preoperative evaluation
Preoperative Evaluation
  • Patient History

- Prior History of Difficult Intubation

- Tumor of Head and Neck

- Arthritis

- Pregnancy

- Trauma - C Spine, Full Stomach

Department of Anesthesiology

Uniformed Services University of the Health Sciences

preoperative evaluation6
Preoperative Evaluation
  • Physical Examination

- Tongue versus Pharyngeal Size

- Atlanto - Occipital Joint Extension

      • Cervical Spine Mobility (normal 35 degrees)

- Anterior Mandibular Space

      • Thyromental distance - normal is 6 cm

- Dental Examination (Loose Teeth, Prostheses)

Department of Anesthesiology

Uniformed Services University of the Health Sciences

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Department of Anesthesiology

Uniformed Services University of the Health Sciences

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Department of Anesthesiology

Uniformed Services University of the Health Sciences

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Department of Anesthesiology

Uniformed Services University of the Health Sciences

technique for orotracheal intubation
Technique For Orotracheal Intubation
  • Preparation And Equipment (Always Have Suction Available)
  • Head Position - Alignment Of Oral, Pharyngeal, and Laryngeal Axes
  • Choice Of Laryngoscope And Endotracheal Tube
  • Possible Need For Awake Tracheal Intubation

- Difficult Airway Algorithm

Department of Anesthesiology

Uniformed Services University of the Health Sciences

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Department of Anesthesiology

Uniformed Services University of the Health Sciences

orotracheal intubation
Orotracheal Intubation
  • Patient’s Head At The Level Of The Xiphoid
  • Sniffing Position
  • Laryngoscope In LEFT Hand
  • Open Mouth
  • Hold Tracheal Tube In Right Hand Like A Pencil

Department of Anesthesiology

Uniformed Services University of the Health Sciences

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Department of Anesthesiology

Uniformed Services University of the Health Sciences

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Department of Anesthesiology

Uniformed Services University of the Health Sciences

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Department of Anesthesiology

Uniformed Services University of the Health Sciences

slide16

Department of Anesthesiology

Uniformed Services University of the Health Sciences

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Department of Anesthesiology

Uniformed Services University of the Health Sciences

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Department of Anesthesiology

Uniformed Services University of the Health Sciences

complications of orotracheal intubation during
Complications Of Orotracheal Intubation (During)
  • Dental And Oral Soft tissue Trauma
  • Hypertension And Tachycardia
  • Cardiac Dysrhythmias And Myocardial Ischemia
  • Aspiration
  • Corneal Damage

Department of Anesthesiology

Uniformed Services University of the Health Sciences

complications of orotracheal intubation intubated patient
Complications Of Orotracheal Intubation (Intubated Patient)
  • Tracheal Tube Obstruction
  • Endobronchial Intubation
  • Barotrauma
  • Accidental Disconnect
  • Tracheal Mucosa Ischemia
  • Accidental Extubation

Department of Anesthesiology

Uniformed Services University of the Health Sciences

immediate and delayed complications on extubation
Immediate And delayed Complications On Extubation
  • Laryngospasm
  • Aspiration
  • Pharyngitis
  • Laryngeal Or Subglottic Edema
  • Vocal Cord Paralysis
  • Arytenoid Cartilage Dislocation

Department of Anesthesiology

Uniformed Services University of the Health Sciences

alternatives to orotracheal intubation under anesthesia
Alternatives To Orotracheal Intubation Under Anesthesia
  • Awake Orotracheal Intubation
  • Nasotracheal Intubation

- Awake Blind Nasal

- Nasotracheal Intubation After Induction

  • Intubation With Fiberoptic Bronchoscope

- Awake versus Under Anesthesia

- Orotracheal versus Nasotracheal

  • Retrograde Intubation

Department of Anesthesiology

Uniformed Services University of the Health Sciences

verification of correct tube placement
Verification Of Correct Tube Placement
  • Symmetric Chest Movement
  • Symmetric Breath Sounds
  • End tidal Carbon Dioxide

- Greater Than 30 For 3-5 Breaths

  • Condensation Of Water In The tube
  • Palpation Of Cuff In Suprasternal Notch
  • Fiberoptic Bronchoscopy

Department of Anesthesiology

Uniformed Services University of the Health Sciences