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Asa difficult airway algorithm
- 1. ASA DIFFICULT AIRWAY ALGORITHM Dr Murugesh Sukumar MD Sr Consultant Anaesthesia and ICU Khawla Hospital Muscat
- 2. Basics Evaluation of the Airway Informing the patient/Bystander Availability of equipment Availability of a Trained Assistant Optimise the position / Preoxygenation
- 3. From: Practice Guidelines for Management of the Difficult Airway:An Updated Report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway Anesthesiology. 2013;118(2):251-270. doi:10.1097/ALN.0b013e31827773b2
- 4. Assess the basic management problems • Difficulty with patient cooperation or consent • Difficult mask ventilation • Difficult supraglottic airway placement • Difficult laryngoscopy • Difficult intubation • Difficult surgical airway access
- 5. Consider the basic management choices • Awake Intubtn vs. Intubtn after induction of GA • Non-Inv. vs. Inv. Techniques initial approach • VAL as an initial approach to intubation • Preservation vs. ablation of spont. ventilation
- 6. Throughout the process of difficult airway Actively deliver supplemental OXYGEN
- 7. Develop primary and alternative strategies AWAKE INTUBATION INTUBATION AFTER INDUCTION OF GA
- 8. AWAKE INTUBATION Airway approached by NON Invasive Airway Access Invasive Airway Access Succeed Fail Cancel case Consider feasibility of other options Invasive airway access
- 9. INTUBATION AFTER INDUCTION OF GA INITIAL INTUBATION ATTEMPTS SUCCESSFUL INITIAL INTUB UNSUCCESSFUL FROM THIS POINT ONWARDS CONSIDER 1.CALL FOR HELP 2.Return to spont ventilation 3.Awaken
- 10. INITIAL INTUBATION ATTEMPTS UNSUCCESSFUL FACE MASK VENTILATION ADEQUATE FACE MASK VENTILATION NOT ADEQUATE
- 11. FACE MASK VENTILATION ADEQUATE NONEMERGENCY PATHWAY Ventilation adequate, intubation unsuccessful Alternative approaches to intubation SUCCESSFUL INTUBATION FAIL AFTER MULTIPLE ATTEMPTS INVASIVE AIRWAY ACCESS CONSIDER FEASIBILTY OF OTHER OPTIONS AWAKEN THE PATIENT
- 12. FACE MASK VENTILATION NOT ADEQUATE CONSIDER/ATTEMPT SGA SGA ADEQUATE SGA NOT ADEQUATE OR NOT FEASIBLE EMERGENCY PATHWAY Ventilation not adequate, intubation unsuccessful Call for help Emergency NON invasive airway ventilation Successful ventilation FAIL Emergency invasive airway access Invasive airway access Consider feasibility of other options Awaken the patient
- 13. From: Practice Guidelines for Management of the Difficult Airway:An Updated Report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway Anesthesiology. 2013;118(2):251-270. doi:10.1097/ALN.0b013e31827773b2
- 14. Follow-up Care Extuabation strategy • Postextubation care and counselling • Documentation of a difficult airway • Registration with notification service
- 15. Thank you !
Editor's Notes
- Evaluation of the Airway: A directed patient history A directed airway physical examination Diagnostic tests (e.g., radiography) Basic Preparation for Difficult Airway Management: Informing the patient with a known or suspected difficult airway Availability of equipment for management of a difficult airway (i.e., a portable storage unit) Availability of an assigned individual to provide assistance when a difficult airway is encountered Preanesthetic preoxygenation by facemask before induction of anesthesia
- Assess the likelihood and clinical impact of basic management problems
- Consider the relative merits and feasibility of basic management choices
- Postextubation care and counselling Documentation of a difficult airway and its management Registration with an emergency notification service