Airway assesment 2 by Dr. Mohammad Abdeljawad

Dr. Mohammad Abdeljawad
6/3/2020 1
Anesthesia specialist
AL-Bashir Hospital

6/3/2020 2
Inadequate preoperative
assessment is one of important
cause of difficult intubation.
Prediction of the difficult airway allows time for proper
selection of equipment, technique and personnel
experienced in difficult airways
Estimated that up to 28% of all anaesthetic related deaths
are secondary to the inability to mask ventilate or
intubate

6/3/2020 5
History
1-previous difficult intubation
2-previous airway surgery
3-teeth problem
4-examination of previous
medical record if available
5-medical history:-congenital
acquired
History

6/3/2020 6
Congenital
Down .s
hydrocphalus
cystic hygroma
Goldenhar.s (micrognathia)
kippel-feil.s (neck rigidity)
-pierre-Robin.s
(micrognathia)
 8-Treacher Collins's
(micrognathia)
marfan.s

6/3/2020 7
(TRISOMY21) DOWN.S
Atlanto-axial instability:
This is seen in about 15% of patients. The instability may be
due to abnormality in the C1 vertebra (atlas) or C2 vertebra
(axis), with laxity of the transverse ligament
-Spinal cord compression is seen in 2% of children
-sub-glottic stenosis -
-Large tongue ,tonsil, adenoid.
-small mouth.
-narrow nasopharynx.
-irregular dentition.
-laryngospasm.
-Generalized poor muscle tone

6/3/2020 8
The incidence of airway obstruction is 1.83
difficult intubation 0.54
Successful use of a laryngeal mask airway (LMA) has been
reported in a child with Down’s syndrome with atlanto-axial
dislocation
• A small tracheal tube may be needed
due to sub-glottic stenosis
Care of the neck during laryngoscopy
and intubation is necessary
Avoid forceful flexion and extension of
the neck in these patients due to the
possibility of atlanto-axial instability.
The head should ideally be placed in
neutral position during surgery.

6/3/2020 9
Marfan.s
hyperextinsibilty of tempromandibular
joint causing dislocation
long high arched palate.
-atlanto-axial instability

6/3/2020 10
Hydrocephalic
pt with neck
flexion
Cystic hygroma

6/3/2020 13
Acquired
pregnancy
obese ,obstructive sleep apnea( OSA )
,pt on CPAP
Rheumatoid arthritis :-
tempromandibular joint stiffness
-cervical spine instability or
sublaxation
Ankylosing spondylatis :spine stiffness
,T-M stiffness
Acromegaly;
Macroglossia ,prognathism ,nasal
polyps, splaying teeth
tumor ,trauma ,abscess ,radiotherapy
,mandibular bone #,wire
fixation
cervical effusion .
head &neck burns.-
Airway surgery

6/3/2020 15
Clinical examination

6/3/2020 17
protruding teeth ,loose teeth,
-mouth opening test :incisor distance
3cm
( 2 finger breadth or more )or more is
desirable
Clinical examination
large tongue, tongue mass, airway
mass,abscess, FB, oedema
heigh arched palate
-mandible ;micrognathia,
retrognathia, mass, abscess
Mallampati classification

6/3/2020 18
-neck:
Mass ,burn ,scar
--short and circumference >27cm
-limitation of movement .
-touch the chest with tip of chin.,

6/3/2020 29
A
B
C
CLASS B and C ASSOCIATED WITH
DIFFICULT LARYNGOSCOPY .
(madibular mobility test);
ask pt to protrude lower teeth:
class A ;lower incisors can protruded
ant to upper incisors .
Class B :lowers incisors edge to edge with
upper incisors.
class C ; lower incisors cannot brought
with upper incisors.

6/3/2020 36
patil,s test
(thyromental distance )
less than 6,5cm or 3finger
breadth with full extension
neck is possible difficult
intubation

6/3/2020 38
-hypo mental ;
2finger between thyroid
notch and hyoid bone

6/3/2020 39
-
distance(SAVVA test)
(Sternomental Distance)
distance between tip
of chin and sternum with full
extended head& closed mouth
less than 12,5cm
possible difficult intubation
-
high sensitivity
&specificity

6/3/2020 46
Original Mallampati Scoring:[1]
Class 1: Faucial pillars, soft palate and uvula could be
visualized.
Class 2: Faucial pillars and soft palate could be visualized, but
uvula was masked by the base of the tongue.
Class 3: Only soft palate visualized.

6/3/2020 57
Modified Cormack-Lehane classification.[2][3]
Grade Description Approximate frequency
Likelihood of difficult
intubation
1 Full view of glottis 68-74% <1%
2a Partial view of glottis 21-24% 4.3-13.4%
2b
Only posterior extremity of
glottis seen or
only arytenoid cartilages
3.3-6.5% 65-67.4%
3
Only epiglottis seen, none of
glottis seen
1.2-1.6% 80-87.5%
4
Neither glottis nor epiglottis
seen
very rare very likely

6/3/2020 61
Anterior mandibular depth :distance between incisor and lower
border of mandible.
Posterior mandibular depth :distance between bony alveolus
immediately behind 3rd molar and lower border of mandible
>2.5cm possible difficult laryngoscopy

6/3/2020 90
Noninvasive ventilation (NIV) allows the
physician to mechanically ventilate a
patient by means of a full-face or nasal
mask instead of an endotracheal tube
Noninvasive ventilation (NIV) is generally defined
as any mode of ventilatory support that is
provided without the use of an endotracheal or
tracheostomy tube

Airway assesment 2 by Dr. Mohammad Abdeljawad

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Similar to Airway assesment 2 by Dr. Mohammad Abdeljawad

Similar to Airway assesment 2 by Dr. Mohammad Abdeljawad (20)

More from Mohammad Abdeljawad

More from Mohammad Abdeljawad (13)

Recently uploaded

Recently uploaded (20)

Airway assesment 2 by Dr. Mohammad Abdeljawad