2. DEFFINATIONDEFFINATION
American society of Anesthesiologist (ASA)American society of Anesthesiologist (ASA)
suggested that when sign of inadequatesuggested that when sign of inadequate
ventilation could not be reversed by maskventilation could not be reversed by mask
ventilation or oxygen saturation could not beventilation or oxygen saturation could not be
maintained above 90% ormaintained above 90% or
if a trained Anaesthetist usinig conventionalif a trained Anaesthetist usinig conventional
larangoscope take’s more than 3 attempts orlarangoscope take’s more than 3 attempts or
more than 10 minute are required to completemore than 10 minute are required to complete
tracheal intubationtracheal intubation
4. PREVALENCEPREVALENCE
Fact of the matter is even with proper evaluationFact of the matter is even with proper evaluation
only 15 to 50 % were picked up whileonly 15 to 50 % were picked up while
difficult face mask ventilation in general isdifficult face mask ventilation in general is
about 1:10,000 out of which again 15% provedabout 1:10,000 out of which again 15% proved
to be the difficult intubation ,while incidenceto be the difficult intubation ,while incidence
of extreme difficult or abandons intubation inof extreme difficult or abandons intubation in
general surgery patients are 1:2000 but ingeneral surgery patients are 1:2000 but in
obstetrics is 1:300 and of course most criticalobstetrics is 1:300 and of course most critical
incidence is Hypoxiaincidence is Hypoxia
5. BASIC AIRWAY EVALUATIONBASIC AIRWAY EVALUATION
1.1. Previous anaesthetic problems and generalPrevious anaesthetic problems and general
appearance of the patient.appearance of the patient.
2.2. Neck, face, maxilla and mandible with jawNeck, face, maxilla and mandible with jaw
movements.movements.
3.3. Head extension and movements, teeth,Head extension and movements, teeth,
oropharanx and soft tissue of the neck .oropharanx and soft tissue of the neck .
6. Why does it happens ?Why does it happens ?
1.1. Exaggerated idea of personal ability.Exaggerated idea of personal ability.
2.2. Not requesting for experienced help.Not requesting for experienced help.
3.3. No discussion with colleagues aboutNo discussion with colleagues about
proposed management of the case .proposed management of the case .
4.4. Ill conceived plan (A) with no proper backIll conceived plan (A) with no proper back
up plan (B).up plan (B).
5.5. Even poorly conducted plan (A) or stickingEven poorly conducted plan (A) or sticking
extra time to the plan (A) other wayextra time to the plan (A) other way
delaying the rescue plan late.delaying the rescue plan late.
6.6. Last not the least not involving surgicalLast not the least not involving surgical
friends.friends.
7. CAUSES OFCAUSES OF
DIFFICULT INTUBATIONDIFFICULT INTUBATION
AnaesthetistAnaesthetist
1.1. Inadequate preoperative assessment.Inadequate preoperative assessment.
2.2. Inadequate equipments.Inadequate equipments.
3.3. Experience not enough.Experience not enough.
4.4. Poor technique.Poor technique.
5.5. Malfunctioning of equipment.Malfunctioning of equipment.
6.6. Inexperience assistananceInexperience assistanance
PatientPatient
1.1. Congenital causesCongenital causes
2.2. Acquired causesAcquired causes
8. Anatomical factors affectingAnatomical factors affecting
LarangoscopyLarangoscopy
1.1. Short Neck.Short Neck.
2.2. Protruding incisor teeth.Protruding incisor teeth.
3.3. Long high arched palate.Long high arched palate.
4.4. Poor mobility of neck.Poor mobility of neck.
5.5. Increase in either anterior depth or PosteriorIncrease in either anterior depth or Posterior
depth of the mandible decrease in Atlantodepth of the mandible decrease in Atlanto
Occipital distance that's why role ofOccipital distance that's why role of
Radiology has increased in our specialtyRadiology has increased in our specialty
9. ASSESSMENT OF AIRWAYASSESSMENT OF AIRWAY
Mallampati classification withMallampati classification with
larangoscopic view.larangoscopic view. Patil’s Test
11. MANAGEMENT PLAN OFMANAGEMENT PLAN OF
ANTICEPATED DIFFICULTANTICEPATED DIFFICULT
AIRWAYAIRWAY
1.1. Discussion with colleagues in advance.Discussion with colleagues in advance.
2.2. Equipment tested before.Equipment tested before.
3.3. Senior help backup.Senior help backup.
4.4. Definite initial plan (A) for ventilation andDefinite initial plan (A) for ventilation and
intubation.intubation.
5.5. Definite plan (B) than option of awakeDefinite plan (B) than option of awake
intubation.intubation.
6.6. Ideal situation surgery team standby.Ideal situation surgery team standby.
12. UNEXPECTED DIFFICULT AIRWAYUNEXPECTED DIFFICULT AIRWAY
ProblemsProblems
1.1. Unexpected encounter with difficult airway is mostly gone worseUnexpected encounter with difficult airway is mostly gone worse
because mainly GA is already given including (NMB,S).because mainly GA is already given including (NMB,S).
2.2. Equipment may not be in hand.Equipment may not be in hand.
3.3. Senior and back up plan not available so delay occur in activeSenior and back up plan not available so delay occur in active
resuscitationresuscitation
TECHNIQUE OF MANAGEMENTTECHNIQUE OF MANAGEMENT
1.1. Manipulation of the patients airway.Manipulation of the patients airway.
2.2. Laryngeal pressure.Laryngeal pressure.
3.3. Nasal or oral airway.Nasal or oral airway.
4.4. Different blades of larangoscope like Miller, Magill, Robershaw , Mackintosh andDifferent blades of larangoscope like Miller, Magill, Robershaw , Mackintosh and
relatively new laryngoscope McCoy.relatively new laryngoscope McCoy.
5.5. Bougies and styletBougies and stylet
6.6. LMA.LMA.
7.7. Combitube.Combitube.
