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Airway Management Anesthesia View

Airway Management Anesthesia View. Andreas Grabinsky, MD Assistant Professor, Dept. of Anesthesiology Program Director and Section Head, Emergency & Trauma Anesthesia Harborview Medical Center. Overview. Airway management in the field Airway management in the hospital Indications

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Airway Management Anesthesia View

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  1. Airway Management Anesthesia View • Andreas Grabinsky, MD • Assistant Professor, Dept. of Anesthesiology • Program Director and Section Head, Emergency & Trauma Anesthesia • Harborview Medical Center

  2. Overview • Airway management in the field • Airway management in the hospital • Indications • Priorities • Problems

  3. OR Airway Management

  4. Field Airway Management

  5. In the OR

  6. OR Setting • 26 Operating rooms • > 1.000 cases per month • 13 Anesthesiology Attendings • 26 Residents / CRNA’s • Start 07:30AM (Wednesday 08:30AM) • 26 potential airways at 07:30AM

  7. The OR Whiteboard

  8. What to do ? • Find the Anesthesiologist in charge • Find the anesthesiologist (covers 2-3 rooms) • Help out • Hope you “get the airway” • Stay in one of the rooms (first rotation) • Find a “late start room” for another airway (second rotation)

  9. Learning Goals • Identify difficult airway • Proficient bag/mask ventilation • Use of alternative airway techniques • Prepare Intubation • Learn about RSI • Demonstrate Laryngoscopy / Intubation

  10. The Intubator

  11. Airway Priorities 1. Oxygenate 2. Ventilate 3. Protect Airway

  12. Airway Management • Spontaneous ventilation • Assisted mask/bag ventilation • Controlled mask/bag ventilation • Intubation + controlled ventilation • Surgical airway + controlled ventilation Use the least aggressive means necessary for airway management

  13. Indications for Intubation • Insufficient Oxygenation • Insufficient Ventilation • Loss of airway protection • Impending airway problems (CNS, Trauma)

  14. Preparation • Oxygen • Ambu bag with mask • Suction • Laryngoscope (working) • different size ETT • Suction • Plan B (Adjuncts)

  15. Prevention of Failure • Assess situation • Decision for specific airway management • Communicate • Plan B • Reassess (change plan, if needed)

  16. Failure to intubate in the OR • Use alternative methods • Get help • Wake patient up

  17. Failure to intubate in the Field • Use alternative methods • Failure is not an option !

  18. Prevention of Failure Do not mess with a perfectly fine airway.

  19. Publications

  20. Airway Assessment

  21. Difficult Airway

  22. Harborview Specials

  23. Indications for Intubation • Insufficient Ventilation • Insufficient Oxygenation • Loss of airway protection • Impending airway problems (CNS, Trauma)

  24. Training

  25. Preparation • Oxygen • Ambu bag with mask • Suction • Laryngoscope (working) • different size ETT • Suction • Plan B

  26. Tools

  27. Real Men use Miller Blades

  28. i-gel

  29. Res-Q-Scope

  30. Glidescope

  31. Glidescope

  32. Glidescope • 25 Paramedic students • Glidescope versus Macintosh 3 blade • 100 intubations in different scenarios on manekin • Significant better visualized glotic opening with Glidescope • Same success rate of 76% • Increased time to intubation with Glidscope Aziz, Michael, Dillman, Dawn, Kirsch, Jeffrey R. and Brambrink, Ansgar(2009)'Video Laryngoscopy with the Macintosh Video Laryngoscope in Simulated Prehospital Scenarios by Paramedic Students',Prehospital Emergency Care,13:2,251 — 255

  33. Res-Q-Scope • 22 US military parmedic (50 manekin and 8 human intubations) • 22 Emergency medicine residents/attending • 20 minutes instruction and 20 minutes training, 3 trials with each device • Intubation time Res-Q-Scope 25.9 seconds • Intubation time direct Laryngoscopy 14.6 seconds Shawn M. Varney MD⁎, Melissa Dooley MD, Vikhyat S. Bebarta MD Faster intubation with direct laryngoscopy vs handheld videoscope in uncomplicated manikin airways American Journal of Emergency Medicine (2009) 27, 259–261

  34. Questions ?

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