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


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

  1. 1. Airway Evaluation and Management <ul><li>Key Learning Objectives </li></ul><ul><li>Review the anatomy relevant to airway management </li></ul><ul><li>Understand the components of an airway examination </li></ul><ul><li>Learn the principles of mask ventilation and intubation </li></ul>
  2. 2. Introduction <ul><li>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. </li></ul><ul><li>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. </li></ul>
  3. 3. Airway Anatomy <ul><li>The human airway is a dynamic structure that extends from the nares to the alveoli. </li></ul><ul><li>Obstruction can occur at any point because of anatomic collapse or a foreign body </li></ul><ul><li>which includes liquids such as mucous, blood, and gastric contents </li></ul>
  4. 6. Pharynx <ul><li>The pharynx is basically a wide muscular </li></ul><ul><li>tube forming the common upper pathway of alimentary </li></ul><ul><li>and respiratory tracts. It extends from the base of the skull </li></ul><ul><li>to the level of C6. </li></ul><ul><li>The pharynx lies posterior to, and communicates with, </li></ul><ul><li>the nose, mouth and larynx. This relationship </li></ul><ul><li>divides the pharynx into three sections: naso-, oro and </li></ul><ul><li>Laryngo pharynx. The posterior surface of the pharynx </li></ul><ul><li>lies on the prevertebral fascia and cervical vertebrae. </li></ul>
  5. 7. Larynx <ul><li>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 </li></ul><ul><li>linked together by ligaments which are moved by a series of muscles. </li></ul>
  6. 8. Cartilages of the larynx <ul><li>The thyroid cartilage is said to be shaped like a </li></ul><ul><li>shield. It consists of two plates that join in the </li></ul><ul><li>midline inferiorly to form the thyroid notch (Adam’s </li></ul><ul><li>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. </li></ul>
  7. 9. <ul><li>The cricoid cartilage is shaped like a signet ring, with the large laminal portion being posterior. </li></ul><ul><li>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 </li></ul><ul><li>arytenoid cartilage. </li></ul>
  8. 10. <ul><li>There is a pair of arytenoid cartilages , each shaped like a triple-sided pyramid possessing medial, posterior and anterolateral surfaces. </li></ul><ul><li>Each arytenoid cartilage projects anteriorly as the vocal process and in a similar fashion laterally as the muscular process. </li></ul><ul><li>The posterior and lateral cricoarytenoid muscles are inserted into the muscular process. </li></ul>
  9. 11. <ul><li>The epiglottis is a leaf-shaped cartilage. It has a lower tapered end which is joined to the thyroid cartilage by the thyroepiglottic ligament. </li></ul><ul><li>The free upper end is broader and projects superiorly behind the tongue. </li></ul><ul><li>The lowest part of the anterior surface of the </li></ul><ul><li>epiglottis is attached to the hyoid by the hyoepiglottic ligament. </li></ul><ul><li>Two other minor cartilages are the corniculate and the cuneiform. </li></ul>
  10. 12. Ligaments of the larynx <ul><li>Extrinsic ligaments are the: </li></ul><ul><li>thyrohyoid membrane, cricotracheal, cricothyroid, and hyoepiglottic ligaments. </li></ul><ul><li>The intrinsic ligaments of the larynx are of minor importance, being the capsules of the small synovial joints </li></ul>
  11. 13. Muscles of the larynx <ul><li>Extrinsic group: </li></ul><ul><li>Sternothyroid, thyrohyoid and inferior constrictor is a constrictor of the pharynx </li></ul><ul><li>Intrinsic group: These are paired, with the exception of the ( transverse arytenoid). </li></ul><ul><li>Cricothyroid, posterior cricoarytenoid, lateral cricoarytenoid, aryepiglottic, thyroarytenoid </li></ul>
  12. 14. Nerve supply <ul><li>The mucous membrane of the larynx above the vocal cords is supplied by the internal laryngeal nerve, that below by the recurrent laryngeal nerve. </li></ul><ul><li>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. </li></ul>
  13. 19. Trachea <ul><li>The trachea descends from the lower border of the cricoid </li></ul><ul><li>cartilage (C6) to terminate at its bifurcation into the two </li></ul><ul><li>main bronchi at the sternal angle (T4). The length of the </li></ul><ul><li>adult trachea varies between 10 and 15 cm. The walls of </li></ul><ul><li>the trachea are formed of fibrous tissue reinforced by 15– </li></ul><ul><li>20 incomplete cartilaginous rings. Internally the trachea </li></ul><ul><li>is lined by respiratory epithelium. The trachea may be </li></ul><ul><li>divided into two portions, that in the neck and that in the </li></ul><ul><li>thorax. </li></ul>
  14. 20. Bronchial tree <ul><li>Extrapulmonary bronchi </li></ul><ul><li>At the carina, the two main bronchi arise. The right </li></ul><ul><li>main bronchus is shorter, wider and more upright than </li></ul><ul><li>the left. The right pulmonary artery and azygos vein are </li></ul><ul><li>intimately related to the right main bronchus. The left </li></ul><ul><li>main bronchus passes under the aortic arch anterior to </li></ul><ul><li>the oesophagus, thoracic duct and descending aorta. The </li></ul><ul><li>structure of the extrapulmonary bronchi is very similar to </li></ul><ul><li>that of the trachea. </li></ul><ul><li>Intrapulmonary bronchi </li></ul><ul><li>Branching of the intrapulmonary bronchi gives rise to </li></ul><ul><li>functional units – the bronchopleural segments. </li></ul>
  15. 22. Tracheal intubation <ul><li>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. </li></ul>
  16. 23. Endotracheal tubes <ul><li>Modified for variety of specialized applications: </li></ul><ul><li>Flexible, wired-reinforced (armored), rubber, </li></ul><ul><li>Microlaryngeal, oral/nasal RAE, double lumen, cuffed non cuffed. </li></ul><ul><li>All endotracheal tubes has a radio-opaque line. </li></ul><ul><li>Airflow resistance depends on tube diameter, curvature and length. </li></ul>