The document provides a comprehensive overview of facemasks and airways used in anesthesia, detailing their types, materials, components, and techniques for effective usage. It covers the functionality of different airway devices, such as oropharyngeal and nasopharyngeal airways, including indications, contraindications, and potential complications. The content emphasizes the importance of proper technique to minimize risks associated with airway management.

1. Facemask and Airways
Presented by: Dr Nayak Rakshat
Guide by: Dr Arvind Gupta
Department of Anesthesia

2. • Facemask is an interference device between the patient’s
upper airway and the breathing system.
• It allows gas administration to the patient from the breathing
system without introducing any apparatus into the patient's
mouth.
• They may be made up of antistatic material to prevent ignition
of anaesthetic gases.

3. DESCRIPTION
• Face masks may be made up of:
• -Black Rubber,
• -Clear Plastic,
• -Elastomeric Material or Disposable Plastic or
• -Combination of these.

4. PARTS OF FACEMASK
• Body ( Shell or Dome)
• Constitutes the main part of the mask
• Transparent facemask allows observation for vomitus,
secretions , blood, lip color, and exhaled moisture and is better
accepted by a conscious patient .

5. Seal (Rim,Flap,Edge)
• It comes in contact with the
face.
Pad (cushion) type seal
• Inflated with air or filled with
a material that will conform
to the face when pressure is
applied.
Flap type seal
• Flexible extension of the
body that conforms to the
contour of the face. It is
pressed onto the face to
create a seal

6. Connector (Orifice,Collar,
Mount)
• Present at the opposite side
from the seal.
• Has a thickened fitting with a
22-mm internal diameter.
• A ring with hooks may be
placed around the connector
to allow a mask strap to be
attached.

7. Face mask-types
• 1) Anatomical mask
Black rubber
Latex
Plastic
• 2) Ambu transparent mask
• 3) Rendell-baker- Soucek mask

8. ANATOMICAL BLACK RUBBER
FACE MASK
• Also called as Connell
mask.
• Body is made of
rubber that can be
widened or narrowed
to fit the face
• Available in sizes 0, 1,
2, 3 & 4.

9. Snuggy Silicone and black
rubber Facemask
• It is autoclavable soft contoured cuff snug facemasks
• its provides patient’s comfort as well as makes for easy
cleaning.
• The one piece construction and silicone rubber also allows for
clear view of presence of vomit, patient’s lip color as well as
other oral secretions.

10. AMBU TRANSPARENT MASK
• Made of transparent
plastic with inflatable cuff
for a seal and has thumb
rest built into the body

11. RENDELL-BAKER-SOUCEK
MASK
• Designed for the pediatric patients,
• Has a triangular body.
• Usually available in sizes 00, 0, 1 & 2
• Has a low dead space
• Adequately fits the child’s face & no special seal is needed.
• Some of these masks are scented and may have a pacifier

12. Endoscopic Masks
• An endoscopic mask is
designed to allow mask
ventilation while an
endoscope is being used
• Port/diaphragm in the mask
body allows a fiberscope to
be inserted into the nose or
mouth.
• A tracheal tube previously
loaded over the fiberscope
can then be advanced, if
desired.

13. SCENTED MASK
uses scents to camouflage the odors of
inhalational agents

14. TECHNIQUES OF USE
• Smallest mask that is appropriate is the most
desirable as it will cause: -
• least increase in dead space
• -easiest to hold
• -less likely to result in pressure on the eyes.

15. One-hand Method
• Mask is holded by dominant hand and placed over the
bridge of the nose and on the chin
• The thumb and index finger of the dominant hand are
placed on the mask body and these finger slightly push
downwards to hold the mask to the face and prevent leak.
• The remaining three fingers are placed on bony part of
the mandible to pull the mandible up into the mask
• Use the free hand to squeeze the reservoir bag
• The middle and ring finger is placed on the mandibular
ridge to pull the jaw backward and extend the neck. Little
finger is placed under the angle of the jaw and pull jaw
upward

17. Two-handed Method
• Mask is placed over the bridge of the nose and on the chin
• index finger and thumb distal phalanges of both hand is
placed along the ridges of the mask
• The remaining fingers are placed on the mandible
• Mandible is pulled up into the mask to perform a jaw-thrust
and chin-lift maneuver
• The assistance squeeze the reservoir bag

18. A: Holding the mask with two hands. Esmarch-Heiberg
maneuver, involves dorsiflexion at the atlanto-occipital
joint and protrusion of the mandible anteriorly by
exerting a forward thrust on the rami.
B: The anesthesiologist's chin on the mask elbow can help
to create a better seal between the mask and the patient's
face.

19. Mask Straps
• A mask strap is used to hold the mask firmly on the face.
• Care needs to be paid when using a mask strap because
obstruction is more likely to go unrecognized than when
the mask is being held by the anesthesia provider's hand.
• A typical mask strap consists of thin strips arranged in a
circle with two or four projections.
• The head rests in the circle, and the straps attach around
the mask connector. The straps at the jaw may tend to pull
the jaw posteriorly.
• Crossing the two lower straps under the chin may result in
a better fit and counteract the pull from the upper straps so
that there is less tendency for the mask to creep up above
the bridge of the nose.

20. Straps should be no tighter than necessary to achieve a seal
in order
to avoid pressure damage from the mask or the straps.
• They should be released periodically and the mask
moved slightly.
• Gauze sponges placed between the straps and the skin
will help to protect the face from excessive pressure.
• Another risk of using a mask strap is that it will take
longer to remove the mask if vomiting or regurgitation
occurs.

21. Complications
• Skin Problems:
• Dermatitis in allergic pts. If rubber is a component of a
face mask, a serious reaction can occur in the patient with
latex allergy.
• Chemical or gas used for sterilization of reusable masks can
cause allergy.
• Pressure necrosis under the face mask
• Nerve Injury:
• Pressure injury to underlying nerves.
• Forward jaw displacement may result in stretching nerve
injury.

22. • Eye Injury: corneal abrasion may be caused by a face
mask inadvertently placed on an open eye
• Pressure on the medial angles of the eyes and
supraorbital margins may result in eyelid edema,
chemosis of the conjunctiva, pressure on the
supraorbital or supratrochlear nerve, corneal injury,
and temporary blindness from central retinal artery
occlusion
• Gastric Inflation of stomach ( So Inspiratory pressure
should be kept<20 cm H2O)
• Foreign Body Aspiration: occur in case of endoscopic
mask

23. OROPHARYNGEAL AND
NASOPHARYNGEAL AIRWAY

24. Pharyngeal Airway
• Most common cause of
airway obstruction is due
to fall back of tongue and
epiglottis into the
posterior pharynx due to
relaxed muscles in the
floor of the mouth and
pharynx supporting the
tongue.

25. AIM OF OROPHARYNGEAL
AIRWAY
• To lift the tongue and epiglottis away from the
posterior pharyngeal wall and
• prevent them from obstructing the space above
the larynx

26. OROPHARYNGEAL AIRWAY
• May be made of elastomeric
material, metal, or plastic
• Curved tube used to provide
free passage of air between
the mouth and pharynx of an
unconscious person
• FLANGE at the buccal end to
prevent Oro-Pharyngeal Axis
from moving deeper into the
mouth and a means to fix the
airway in place

27. BITE PORTION is short firm and straight portion that fits
between the teeth or gums, prevents patient biting and
obstructing the air channel
CURVED PORTION corresponds to the curvature of the
tongue and oropharynx for their effective separation,
The pharyngeal end rests between the posterior wall of
the pharynx and the base of the tongue, by exerting
pressure along the base of the tongue, also pulls the
epiglottis forward.

28. USES
• Helps to maintain an open airway in unconscious patient.
• Prevents a patient from biting and occluding an oral
endotracheal tube.
• Protect the tongue from biting.
• Facilitate oropharyngeal suctioning.
• Provides a pathway for inserting devices into the esophagus
or pharynx

29. SPECIFIC AIRWAYS
WATERS AIRWAY
• made of metal
• an oval flange, a straight bite
block section, an
anatomically curved
pharyngeal section
• holes at the side near the
distal end
• Discarded due to its
propensity to damage teeth
and soft tissue and inability
to see any foreign material
lodged within it.

30. GUEDEL’s AIRWAY
• single use
• integrated bite block, colour
coded
• smooth bevelled tip for easy
insertion and minimising the
risk of trauma
• available in 9 size depnding
on distance between the
center of the incisors and the
angle of the jaw.

31. • 000, 00, 0, 1- 6 with length of 30 to 110 mm.
• size #000 and 00 are for premature and full term new born
babies respectively. Size 0, 1 and 2 are for children and rest are
for adults

32. • BERMAN
• • has a center support and
channels along each side that
allow a suction catheter or
ETT to slide into the
pharyngeal space.
• WILLIAMS AIRWAY
INTUBATOR
• proximal half is cylindrical,
while the distal half is open
on its lingual surface.
• designed for blind
orotracheal intubations

33. PATIL-SYRACUSE ENDOSCOPIC
AIRWAY
• made from aluminum
• designed to aid fiberoptic intubation
• has lateral channels and a central groove on the lingual
surface to allow a fiberscope with a tracheal tube to pass
• slit at the distal end allows the fiberscope to be manipulated
in the AP direction.

34. OVASSAPIAN FIBEROPTIC
INTUBATING AIRWAY
• Designed to deliver a
fiberscope as close to the
larynx as possible
• at the buccal end are two
vertical sidewalls and
between them is a pair of
guide walls that curve toward
each other.

35. BERMAN
INTUBATING/PHARYNGEAL
AIRWAY
• Tubular along its entire
length
• Open on one side so that it
can be split and removed
from around a tracheal tube
used as an oral airway or as
an aid to fiberoptic or blind
orotracheal intubation.

36. Technique of Insertion
• Pharyngeal and laryngeal
reflexes should be depressed.
• correct size estimated by
holding the airway next to the
patient's mouth. The tip should
rest cephalad to the angle of
the mandible.
• lubricate the airway
• the jaw is opened with the
left hand
• the airway is inserted with its
concave side facing the upper
lip

37. • When the junction of the bite portion and the curved section
is near the incisors, the airway is rotated 180° and slipped
behind the tongue into the final position.

38. NASOPHARYNGEAL AIRWAY
• Resembles a shortened
tracheal tube with a flange at
the outer end to prevent it
from completely passing into
the naris
• Flange is movable in some
models.
• When fully inserted, the
pharyngeal end should be
below the base of the tongue
but above the epiglottis

39. USES
• Used during and after pharyngeal surgery
• To apply continuous positive airway pressure (CPAP)
• To facilitate suctioning and as a guide for nasogastric tube.
• as a guide for a fiberscope and to maintain ventilation during
fiberoptic endoscopy
• To dilate the nasal passages in preparation for nasotracheal
intubation
• Used in dental surgery
• can be fitted with a tracheal tube connector and used with an
anesthesia breathing system

40. LINDER NASOPHARYNGEAL
AIRWAY
• made of plastic with a large
flange
• distal end lacks bevel
• supplied with an introducer,
which has a balloon on its tip
that can be inflated and
deflated by attaching a
syringe to the one -way valve
at the other end .

41. CUFFED NASOPHARYNGEAL
AIRWAY
• similar to a short cuffed
tracheal tube
• inserted through the nose
into the pharynx, the cuff is
inflated, and then is pulled
back until resistance is felt.
• BINASAL AIRWAY
• consists of two nasal airways
joined together by an
adaptor for attachment to
the breathing system
• • used to administer
anaesthesia or to provide
CPAP to babies

42. INSERTION
• Diameter of the nasal airway should be the same as needed
for a tracheal tube (0.5 to 1 mm smaller than for an oral
tracheal tube)
• Lubricated thoroughly along its entire length.
• Inspect each nostril for size, patency, and the presence of
polyps
• Use vasoconstrictor drops before insertion
• Airway is held with the bevel against the septum and gently
advanced posteriorly while being rotated back and forth. If
resistance is encountered during insertion, the other nostril or
a smaller size airway should be used.

43. • Correct method :NPA is
inserted
perpendicularly, in line
with the nasal passage
• Incorrect method : The
airway is being pushed
toward the roof of the
nose and into the
turbinates

44. Contraindications Of
Nasopharyngeal Airway
• Anticoagulation;
• Basilar skull fracture;
• Pathology(polyp), or deformity of the nose or
nasopharynx;
• Bleeding disorder or a history of nose bleeds
requiring medical treatment.

45. COMPLICATIONS
• Airway Obstruction
• The tip of an airway can press the epiglottis or tongue against
the posterior pharyngeal wall and cover the laryngeal
aperture.
• With a nasopharyngeal airway, neck movement in rotation or
anteroposteriorly may result in the lumen becoming
obstructed. The use of a fenestrated airway may overcome
this problem.
• The nasopharyngeal airway lumen may be compressed inside
the nose tip can press the epiglottis or tongue against the
posterior pharyngeal wall

46. • Trauma
Injury to the nose and posterior pharynx may cause epistaxis .
• Central Nervous System trauma
can occur if the patient has basilar skull fracture and if the
nasal airway enters the anterior cranial fossa.
• Tissue Edema:
Ulceration and Necrosis of the nose or tongue can occur. Dental
Damage Laryngospasm and Coughing Retention, Aspiration, or
Swallowing, Allergic Reaction to Latex, Gastric Distention

47. THANK YOU