Transcript DIFFICULT AIRWAY ASSESSMENT AND MANAGEMENT

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
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
1.
2.
3.
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 ?
1.
2.
3.
4.
5.
6.
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
1.
2.
3.
4.
5.
6.
Anaesthetist
Inadequate preoperative assessment.
Inadequate equipments.
Experience not enough.
Poor technique.
Malfunctioning of equipment.
Inexperience assistanance
Patient
1.
2.
Congenital causes
Acquired causes
Anatomical factors affecting
Larangoscopy
1.
2.
3.
4.
5.
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’s Test
Measurement of
Atlanto-Occepital Angle
MANAGEMENT PLAN OF
ANTICEPATED DIFFICULT AIRWAY
1.
2.
3.
4.
5.
6.
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
1.
2.
3.
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
1.
2.
3.
4.
5.
6.
7.
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
alternative
1
Manipulation of airway
different blade, bugie
2
alternative
2
LMA, ILMA, Combitube
3
3
Trantracheal Jet Ventilation
alternative
4
alternative
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