This document discusses airway assessment and management for intubation. It describes indications for intubation including respiratory failure and surgery near the airway. It covers assessing risks for difficult intubation such as congenital anomalies, tumors, or neck injuries. Mallampati score and thyromental distance are discussed. Equipment for intubation including laryngoscopes, endotracheal tubes, stylets, airways, and monitoring tools are also outlined. Proper positioning of the head and neck is emphasized to optimize intubation.

1. DR. PALLAVI

2. Indication
1.For supporting ventilation in
patient with some pathologic
disease
 Upper Airway Obstruction
 Respiratory failure
 Loss of conciousness

3. 2) For supporting ventilation during
general anesthesia
Type of surgery :
Operative site near the airway
Abdominal or thoracic surgery
Prone or lateral position
Long period of surgery

4. ANATOMY OF AIRWAY

5. AIRWAY
ASSESSMENTS1) Condition that associated with difficult
intubation
 Congenital anomalies ---> Down’s
syndrome
 Infection in airway--> Retropharyngeal
abscess, Epiglottitis
Tumor in oral cavity or larynx

6. AIRWAY ASSESSMENT
Enlarge thyroid gland
trachea shift to
lateral or
compressed
tracheal lumen

7. AIRWAY ASSESSMENT
 Burn scar at face and neck
 Temperomandibular joint dysfunction
 Maxillofacial ,cervical or laryngeal trauma

8. AIRWAY ASSESSMENT
2) Interincisorgap : normal -> morethan 3 cms

9. AIRWAY ASSESSMENT
3) Mallampati classification: Class 3,4 ->may be
difficult intubation
Soft palate
Uvula

10. AIRWAY ASSESSMENT
Laryngoscopicview
grade 3,4 -> risk for difficult intubation

11. AIRWAY ASSESSMENT
4) Thyromentaldistance:morethan6 cms

12. AIRWAY ASSESSMENT
5)Flexion andextensionofneck

13. AIRWAY ASSESSMENT
6) Movement oftemperomandibularjoint (TMJ)

15. 1) Laryngoscope : handle and
blade

16. 2) Endotracheal tube

17. 1) Size of endotracheal tube : internal
diameter (ID)
Male: ID 8.0 mms . Female : ID 7.5
mms
 New born –
3 months : ID 3.0 mms
 3-9 months : ID 3.5 mms
 9-18 months : ID 4.0 mms
 2- 6 yrs : ID = (Age/3) + 3.5
 > 6 yrs : ID = (Age/4) + 4.5

18. 2) Material:RedrubberorPVC
3) Endotrachealtube cuff
High volume
Low pressure cuff
Low volume
High pressure cuff

19. 4) Bevel
5) Murphy’s eye

20. 6) Depth of endotracheal tube : Mid
trachea or below vocal cord ~ 2 cms
Adult -> Male = 23 cms
Female = 21 cms
 Children
Oral endotracheal tube = (Age/2) + 12 (cm)
Nasal endotracheal tube = (Age/2) + 15 (cm)

21. 7) Tube markings
Z-79
Disposible (Do not reuse)
Oral/ Nasal
Radiopaque marker

22. 3) Other equipments
3.1 Stylet

23. 3.2 Oropharyngeal or nasopharyngeal
airway
Oral airway Nasal airway

24. 3.3) Suction catheter

25. 3.5) Face mask and self inflating bag
3.6) Magill forcep

26. 3.7) Syringe
3.8) Lubricating jelly
3.9) Plaster for strap endotracheal tube
4. Monitoring success of
endotracheal
intubation
4.1) Stethoscope
4.3) Pulse oximeter

27. Flexion at lower cervical spine
Extension at atlanto-occipital joint

28. Sniffing position