2. Definition
Difficult Airway :
the clinical situation in which a conventionally
trained anesthesiologist experiences difficulty with
facemask ventilation of the upper airway, difficulty
with tracheal intubation, or both.
American Society of Anesthesiologist : Practice
Guidelines for Management of The Difficult
Airway, An update report, 2003
4. Tracheal intubation is best
achieved in the classic
"sniffing the morning
air" position in which the
neck is flexed and
there is extension at
the cranio-cervical
(atlanto-axial) junction
• the structures of the upper airway in the
optimum position for laryngoscopy and
permits the best view of the larynx
11. Grading the Airway (Cormack-Lehane)
Figure 2 – Cormack-Lehane
Grade I
- Full view of the glottic opening
Grade II
- Posterior portion of glottic opening visible
Grade III
- Only tip of epiglottis is visible
Grade IV
- Only soft palate is visible
12. LM-MAP
Look for external face deformities
Mallampati
Measure 3-3-2-1 fingers
Atlanto-occipital extension
Pathological obstructive conditions
14. Wilson Risk Score
Weight (0=<90kg,1=90-110kg,2=>110kg)
Head and neck movement (0=>90 ,1=90 ,2=<90 )
Jaw movement (0=IG>5cm,SL>0, 1=IG<5cm,SL=0,
2=IG<5cm,SL<0)
Receding mandible (0=normal, 1=moderate, 2=severe)
Buck teeth (0=normal, 1=moderate, 2=severe)
Total max 10 points
17. Persiapan Dasar Intubasi Sulit
- Laringoskop berbagai ukuran
- ETT berbagai ukuran
- Introducer (stylet, elastic bougie)
- Oral dan nasal airway
- Set krikotirotomi
- Suction
- Assistant yang terlatih
- LMA berbagai ukuran
18.
19. - Preoksigenisasi 100% O2
- Posisi pasien optimal untuk ventilasi dan intubasi
- Konfirmasi ETT setelah intubasi dilakukan
20. Special techniques for intubation
• Awake intubation under local anaesthesia
– The aim is to anaesthetise the upper airway using local
anaesthetic
– This avoids the need for general anaesthesia and muscle
relaxants to facilitate intubation
– This technique may be performed using either a fibreoptic
flexible bronchoscope or other fibrescope or using
direct laryngoscopy
– Atropine 500 mcg or glycopyrrolate 200 mcg should be given
intramuscularly half an hour before intubation to dry the
mucous membranes
21. Awake tracheostomy performed under local
anaesthesia is the best solution when a patient is an
impossible intubation,
sedation with ketamine has been used to facilitate
this approach
23. Alogaritma jalan nafas sulit
Diciptakan oleh American Society of
Anesthesiologists(ASA) pada tahun 1993 dan
diperbaharui pada tahun2003
Dimulai dengan menentukan apakah
“difficulty airway” bisa dikenali/diketahui
(reconigzed) atau tidak bisa dikenali/diketahui
(unrecognized)
26. REMEMBER.....
- Pada jalan nafas sulit (ventilasi dan intubasi),
intubasi awake adalah pilihan terbaik
- Pelumpuh otot diberikan apabila sudah pasti tidak
ada kesulitan ventilasi