DIFFICULT AIRWAY ASSESSMENT AND MANAGEMENT

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DIFFICULT AIRWAYASSESSMENT ANDMANAGEMENT

• BY
• DR AZHAR

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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 takes more than 3 attempts or
• more than 10 minute are required to complete
  tracheal intubation

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Anatomy of oropharynex and larynx
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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
  110,000 out of which again 15 proved to be the
  difficult intubation ,while incidence of extreme
  difficult or abandons intubation in general
  surgery patients are 12000 but in obstetrics is
  1300 and of course most critical incidence is
  Hypoxia

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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 .

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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.

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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

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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

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ASSESSMENT OF AIRWAY

• Mallampati classification with larangoscopic
  view.

Patils Test
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Measurement of Atlanto-Occepital Angle
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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.

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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.

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1 Manipulation of airway different blade,
bugie 2 LMA, ILMA, Combitube 3 Trantracheal
Jet Ventilation 4 Cricothireotomy,
Tracheostomy
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GALLERY OF TOOLS
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GALLERY OF TOOLS

• Bullard laryngoscope Fiber optic

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Mini Tracheostomy
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Mini Tracheostomy (Cont.)
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BLIND NASAL,RETROGRADE AND HIGH FREQUENCY
VENTILATION
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Awake Intubation
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ASA ALLOGORYTHAM
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ASA ALLGORYTHAM
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C-SPINE OA
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THANK YOU VERY MUCH FOR YOUR ATTENTION