Airway management- INTUBATION.pptx
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The document provides information on airway anatomy, evaluation of the airway, and clinical management of the airway. It discusses airway anatomy, including the structures making up the upper airway. It describes methods for evaluating the airway, such as patient history, physical examination, and special investigations. Key points of the physical exam and factors associated with difficult intubation are highlighted. Basic and advanced techniques for managing the airway are outlined, including use of oral/nasal airways, face masks, laryngoscopy, intubation, tracheostomy and handling difficult airway situations. Potential complications of these techniques are also summarized.
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Airway management- INTUBATION.pptx
- 1. AIRWAY MANAGEMENT VIKRAM SINGH RAJAWAT M.Sc (M), M.Sc (N), MBA JNUIMSRC, JAIPUR
- 2. “Management of the Patient’s Airway”
- 3. What should we know about “airway management”? ● Airway anatomy andfunction ● Evaluation of airway ● Clinical management of theairway - Maintenance and ventilation - Intubation and extubation - Difficult airway management
- 4. Airway anatomy The term “airway” refers to the upper airway, consistingof ● Nasal and oral cavities ● Pharynx ● Larynx ● Trachea ● Principle bronchi
- 7. Larynx in laryngoscopic view
- 9. Vagus nerve • Superior laryngeal n – External br (Motor) • cricothyroid m – Internal br (Sensory) • area abovecord • Recurrent laryngeal n - Motor br • intrinsic m – Sensory br • area belowcord SL RL
- 10. Evaluation of the airway ●History ●Physical examination ●Special investigation
- 11. Evaluation of the airway “History” ● Previous history of difficult airway ● Airway-related untowardevents ● Airway-related symptoms/diseases
- 12. Evaluation of the airway Physical examination ● Ease of open airwayand maintenance ● Ease of tracheal intubation ● Teeth ● Neck movement ● Intubation hazards ● Signs of airwaydistress
- 13. Evaluation of the airway Anatomic characteristicsassociated with difficult airwaymanagement ● Short muscular neck ● Receding mandible ● Protruding maxillary incisors ● Long high-arched palate ● Inability to visualize uvula ● Limited temporomandibular joint mobility ● Limited cervical spine mobility ● Interincisor distance < 2 FB or 3 cm
- 14. Evaluation of the airway ● Mallampati’s classification ● Hyoid-mental distance ● Thyromental distance ● Horizontal length of mandible ● Sternomental distance Assessment of airway associated with difficult airway management > Class III ● Atlanto-occipital joint extension < 35O < 3 cm or 2 FB < 6 cm or 3 FB < 9 cm < 12 cm
- 15. Mallampati’s classificaton Soft palate Fauces Uvula Soft palate Hard palate Soft palate Fauces Uvula Pillar
- 16. Signs of upper airway obstruction/airway distress ● Hoarse voice ● Decreased air in andout ● Stridor ● Retraction of suprasternal / supraclavicular / intercostalspace ● Tracheal tug ● Restlessness ● Cyanosis
- 17. How to open the airway? Non equipment With equipment :- head tilt / chin lift / jaw thrust :- oral/nasopharyngeal airway - endotracheal intubation - laryngeal mask airway (LMA) - tracheostomy
- 18. Basic Airway Management (Manual / Non equipment) 1. Head tilt 2. Chin lift 3. Jaw thrust
- 19. Face Mask 22 mm orifice Transparent/ black rubber Hook Minimize dead space
- 20. One-handed face mask technique
- 21. Two-handed face mask technique
- 23. Indications for tracheal intubation ● Airway protection ● Maintenance of patent airway ● Pulmonary toilet ● Application of positive pressure ventilation ● Maintenance of adequate oxygenation ● Route for emergency drug during cardiac arrest
- 24. Technique of Direct Laryngoscopy &Intubation
- 28. 0 1 / 1 1 / 5 6 BencharatanaYokubol 28 Cormack - Lehane grading system Laryngoscopic view ( LV classification) Grade I Grade II Grade III Grade IV
- 29. Oral endotracheal tube size guideline Age Int diameter (mm) Length (cm) Full term 3.5 12 Child 4 +Age/4 12+Age/2 Adult Female Male 7.0 – 7.5 7.5 – 8.0 20-23 21-24
- 30. Preparation for Rigid Laryngoscopy ● Suction ● Airway ● Laryngoscope ● Endotracheal tube (ET or ETT) ● Stylet ● Anesthetic machine / Breathing system / Self- inflating bag ● Monitoring : Pulse oximeter, Capnograph, ECG ● Local anesthetics infiltration / spray
- 31. Stylet
- 32. Signs of Tracheal Intubation • Respiratory gas moisture disappearing on inhalation and reappearing on exhalation • Chest rise & fall • No gastric distention • ICS filling out during inspiration • Reservoir bag having the appropriate compliance
- 33. Signs of Tracheal Intubation ● Breath sounds over chest wall ● No breath sounds over stomach ● Hearing air exit from ET whenchest is compressed ● Large spontaneous exhaled tidal volumes
- 34. Signs of Tracheal Intubation “More reliable signs” ● CO2 excretion waveform ● Rapid expansion of a tracheal indicator bulb
- 35. Signs of Tracheal Intubation “Most reliable signs” • ET visualized between vocal cords • Fiberoptic visualization of cartilaginous rings of the trachea and tracheal carina
- 36. Techniques for routine intubation ● (Preoxygenation) ● Administration of induction agent ● Adequate mask ventilation ● Administration of neuromuscular (NM) blocking agent ● Continue mask ventilation ● Intubation ● Confirm ET in trachea
- 37. Techniques for “rapid-sequence” (crash) induction and intubation ● Preoxygenation 5 min (or 8 deep breaths) ● Administration of induction and NM blocking agents ● Cricoid pressure (Sellick’smaneuver) ● “No” mask ventilation ● Intubation ● Check ET in trachea ● Release cricoid pressure
- 40. Complications: • During laryngoscopy & intubation • While tube in place • Following extubation
- 41. Complications: During laryngoscopy & intubation ● Malpositions - Esophageal intubation - Bronchial intubation ● Trauma - Dental damage - Lip, tongue, pharyngeal, laryngeal, tracheobronchial injuries - Dislocated mandible - Retropharyngeal dissection - Cervical spine injury ● Aspiration
- 42. During laryngoscopy & intubation ● Physiologic reflexes –HT, arrthymia –Intracranial HT –Intraocular HT –Bronchospasm ● Tube malfunction –Cuff perforation Complication:
- 43. Oropharyngeal airway Nasopharyngeal airway
- 44. While tube in place ● Malpositioning – Unintentional extubation – Endobronchial intubation – ET cuff malposition ● Airway trauma – Mucosal inflammation – Excruciation ofnose ● Tube malfunction – Ignition – Obstruction / Kinking ● Aspiration Complications:
- 45. Following Extubation ● Airway trauma –Edema, Stenosis –Hoarseness / Sorethroat –Laryngeal trauma / malfunction ● Physiologic reflexes ● Laryngospasm ● Aspiration Complications:
- 47. Techniques of Intubations ● Oral/Nasal AirwayInsertion ● Two-person mask ventilation ● Laryngeal mask airway(LMA) ● Esophageal-trachealcombitube ● Surgical airwayaccess
- 48. Two person Mask Ventilation Second person Three-hand jaw-thrust/mask seal Two-hand jaw-thrust/maskseal First person First person Second person
- 53. ● Stylet ● Awake intubation ● Blind intubation (oral or nasal) ● Fiberoptic intubation ● Illuminating stylet / Light wand ● Surgical airway access Techniques for Difficult Intubation
- 54. Stylet
- 59. Supragloltic airway (SGA) • Laryngeal mask airway (LMA) • Intubation LMA (ILMA) • Laryngeal tube
- 60. Thank you