Lecture Title: Airway Evaluation and Management

1. Lecture Title: Airway Evaluation and Management Lecturer name: Lecture Date:

2. Lecture Objectives.. Students at the end of the lecture will be able to: • Learn about basic airway anatomy • Conduct a preoperative airway assessment • Identify a potentially difficult airway • Understand the issues around aspiration and its prevention • Learn about the management of airway obstruction • Become familiar with airway equipment • Practice airway management skills including bag and mask ventilation, laryngeal mask insertion, endotracheal intubation • Learn about controlled ventilation and become familiar with ventilatory parameters • Appreciate the different ways of monitoring oxygenation and ventilation

3. Indications of intubation • Resuscitation (CPR) • Prevention of lung soiling • Positive pressure ventilation (GA) • Pulmonary toilet • Patent airway (coma or near coma) • Respiratory failure(CO2 retention )

4. Requirement of successful intbatin • 1-Normal roomy mandible • 2-Normal T-M, A-O , and C-spine

5. Requirements of successful intubation 3-Alignment of 3 axes or Assuming sniffing position -Any anomaly in these 3 joints A-O, T-M or C-spine can result In difficult intubation

6. Requirement of successful intubation Proper equipment -Bag and mask,oxygen source -Airways oro and nasopharyngeal -Laryngosopes different blades -ETT different sizes -suction on

7. Airway gadgets

8. Management I-History: previous history of difficulty is the best predictor Inquire about:-Nature of difficulty -No of trials -Ability to ventilate bet trials -Maneuver used -Complications II-Snoring and sleep apnea( prdictors of DMV)

9. Examination -Look for any obvious anomaly • Morbid obesity(BMI) • Skull • Face • Jaw • Mouth,teeth • Neck

10. Examination I-The 3 joints movements • A-O joint(15-20 degrees) Presence of a gap bet the Occiput and C1 is essential • The cervical spine(range>90) • T.M joint:-interdental gap(3 fingers) • -subluxation (1 finger)

11. Examination II-Measurements of the mandible -Thyro-mental distance (head extended) Normally 6.5 cm Less than 6 cm=expect difficulty

12. Tests to predict difficulty Mallampatti test: Based on the hypothesis That when the base of the Tongue is disproportionally Large it will overshadow the larynx

13. -Simple easy test,correlates with what is seen during laryngoscopy or Cormack-Lehene grades ,but 1-moderate sensitivity and specificity(12% false +ve) 2-Inter observer variation 3-Phonation increases false negative view

14. II-Wilson test -Consists of 5 easily assessed factors • Body wight(n=0 ,>90=1,>110=2) • Head and neck movement • Jaw movement • Receding jaw • Buck teeth Each factor assigned as o ,1 ,2 max is 10

15. Difficult airway • Expected from history,examination Secure airway while awake under LA • Unexpected different options Priority for maintenance of patent airway and oxygenation

16. Airway gadgets

18. Needle cricothyroidotomy

19. Confirm tube position • Direct visualization of ETT between cords • Bronchoscopy ;carina seen • Continuous trace of capnography • 3 point auscultation • Esophageal detector device • Other as bilateral chest movement,mist in the tube,CXR

20. Rapid sequence induction • Indications • Technique: -Preoxygenation -IV induction with sux -Cricoid pressure -Intubate, inflate the cuff ,confirm position -Release cricoid and fix the tube

21. Complications of intubation 1-Inadequate ventilation 2-Esophageal intubation 3-Airway obstruction 4-Bronchospasm 5-Aspiration 6- Trauma 7-Stress response

22. Recommendations • Adequate airway assessment to pick up expected D.A to be secured awake • Difficult intubation cart always ready • Pre oxygenation as a routine • Maintenance of oxygenation not the intubation should be your aim • Use the technique you are familiar with • Always have plan B,C,D in unexpected D.A

23. Reference book and the relevant page numbers..

24. Thank You  Dr. Date: