anaesthesia.Airway evaluation and management 1.(dr.amr)
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anaesthesia.Airway evaluation and management 1.(dr.amr)

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anaesthesia.Airway evaluation and management 1.(dr.amr) anaesthesia.Airway evaluation and management 1.(dr.amr) Presentation Transcript

  • Airway Evaluation and Management
    • Key Learning Objectives
    • Review the anatomy relevant to airway management
    • Understand the components of an airway examination
    • Learn the principles of mask ventilation and intubation
  • Introduction
    • Despite the site of surgery or the anesthetic technique chosen, every patient receiving anesthetic care is exposed to a varying degree of risk of airway compromise. That is, all levels of sedation, general anesthesia, and regional anesthesia carry with them at least a small risk of airway obstruction and apnea.
    • Therefore, every anesthesia provider must examine each patient in anticipation of a need to mechanically ventilate and intubate, regardless of whether or not such interventions were part of the primary anesthetic plan. A thorough airway examination and history, combined with expert airway management, guard against the life-threatening risks of airway obstruction and apnea.
  • Airway Anatomy
    • The human airway is a dynamic structure that extends from the nares to the alveoli.
    • Obstruction can occur at any point because of anatomic collapse or a foreign body
    • which includes liquids such as mucous, blood, and gastric contents
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  • Pharynx
    • The pharynx is basically a wide muscular
    • tube forming the common upper pathway of alimentary
    • and respiratory tracts. It extends from the base of the skull
    • to the level of C6.
    • The pharynx lies posterior to, and communicates with,
    • the nose, mouth and larynx. This relationship
    • divides the pharynx into three sections: naso-, oro and
    • Laryngo pharynx. The posterior surface of the pharynx
    • lies on the prevertebral fascia and cervical vertebrae.
  • Larynx
    • The larynx is a functional sphincter at the beginning of the respiratory tree to protect the trachea from foreign bodies. It is lined by ciliated columnar epithelium and consists of a framework of cartilages
    • linked together by ligaments which are moved by a series of muscles.
  • Cartilages of the larynx
    • The thyroid cartilage is said to be shaped like a
    • shield. It consists of two plates that join in the
    • midline inferiorly to form the thyroid notch (Adam’s
    • apple). Each plate has a superior and inferior horn or cornua at the upper and lower limit of its posterior border, respectively. The inferior horn articulates with the cricoid cartilage.
    • The cricoid cartilage is shaped like a signet ring, with the large laminal portion being posterior.
    • Each lateral surface features a facet that articulates with the inferior horn of the thyroid cartilage. The upper border of the lamina has an articular facet for the
    • arytenoid cartilage.
    • There is a pair of arytenoid cartilages , each shaped like a triple-sided pyramid possessing medial, posterior and anterolateral surfaces.
    • Each arytenoid cartilage projects anteriorly as the vocal process and in a similar fashion laterally as the muscular process.
    • The posterior and lateral cricoarytenoid muscles are inserted into the muscular process.
    • The epiglottis is a leaf-shaped cartilage. It has a lower tapered end which is joined to the thyroid cartilage by the thyroepiglottic ligament.
    • The free upper end is broader and projects superiorly behind the tongue.
    • The lowest part of the anterior surface of the
    • epiglottis is attached to the hyoid by the hyoepiglottic ligament.
    • Two other minor cartilages are the corniculate and the cuneiform.
  • Ligaments of the larynx
    • Extrinsic ligaments are the:
    • thyrohyoid membrane, cricotracheal, cricothyroid, and hyoepiglottic ligaments.
    • The intrinsic ligaments of the larynx are of minor importance, being the capsules of the small synovial joints
  • Muscles of the larynx
    • Extrinsic group:
    • Sternothyroid, thyrohyoid and inferior constrictor is a constrictor of the pharynx
    • Intrinsic group: These are paired, with the exception of the ( transverse arytenoid).
    • Cricothyroid, posterior cricoarytenoid, lateral cricoarytenoid, aryepiglottic, thyroarytenoid
  • Nerve supply
    • The mucous membrane of the larynx above the vocal cords is supplied by the internal laryngeal nerve, that below by the recurrent laryngeal nerve.
    • All muscles of the larynx are supplied by the recurrent laryngeal nerve except for the cricothyroid, which is supplied by the superior (also known as external) laryngeal nerve.
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  • Trachea
    • The trachea descends from the lower border of the cricoid
    • cartilage (C6) to terminate at its bifurcation into the two
    • main bronchi at the sternal angle (T4). The length of the
    • adult trachea varies between 10 and 15 cm. The walls of
    • the trachea are formed of fibrous tissue reinforced by 15–
    • 20 incomplete cartilaginous rings. Internally the trachea
    • is lined by respiratory epithelium. The trachea may be
    • divided into two portions, that in the neck and that in the
    • thorax.
  • Bronchial tree
    • Extrapulmonary bronchi
    • At the carina, the two main bronchi arise. The right
    • main bronchus is shorter, wider and more upright than
    • the left. The right pulmonary artery and azygos vein are
    • intimately related to the right main bronchus. The left
    • main bronchus passes under the aortic arch anterior to
    • the oesophagus, thoracic duct and descending aorta. The
    • structure of the extrapulmonary bronchi is very similar to
    • that of the trachea.
    • Intrapulmonary bronchi
    • Branching of the intrapulmonary bronchi gives rise to
    • functional units – the bronchopleural segments.
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  • Tracheal intubation
    • usually simply referred to as intubation , is the placement of a flexible plastic or rubber tube into the trachea to maintain an open airway or to serve as a conduit through which to administer certain drugs.
  • Endotracheal tubes
    • Modified for variety of specialized applications:
    • Flexible, wired-reinforced (armored), rubber,
    • Microlaryngeal, oral/nasal RAE, double lumen, cuffed non cuffed.
    • All endotracheal tubes has a radio-opaque line.
    • Airflow resistance depends on tube diameter, curvature and length.
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