Difficult airway
- 1. DIFFICULT AIRWAYDIFFICULT AIRWAY ASSESSMENT ANDASSESSMENT AND MANAGEMENTMANAGEMENT BYBY DR AZHARDR AZHAR
- 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
- 3. Anatomy of oropharynex and larynxAnatomy of oropharynex and larynx
- 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
- 10. Measurement ofMeasurement of Atlanto-Occepital AngleAtlanto-Occepital Angle
- 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.
- 13. 1 alternative 1 alternative 2 alternative 2 alternative 3 alternative 3 alternative 4 alternative 4 alternative 1 Manipulation of airway different blade, bugie 2 LMA, ILMA, Combitube 3 Trantracheal Jet Ventilation 4 Cricothireotomy, Tracheostomy
- 14. GALLERY OF TOOLSGALLERY OF TOOLS
- 15. GALLERY OF TOOLSGALLERY OF TOOLS Bullard laryngoscope Fiber opticBullard laryngoscope Fiber optic
- 17. Mini Tracheostomy (Cont.)Mini Tracheostomy (Cont.)
- 18. BLIND NASAL,BLIND NASAL, RETROGRADERETROGRADE AND HIGH FREQUENCY VENTILATIONAND HIGH FREQUENCY VENTILATION
- 23. THANK YOUTHANK YOU VERY MUCHVERY MUCH FOR YOURFOR YOUR ATTENTIONATTENTION