Presentation on theme: "DIFFICULT AIRWAY ASSESSMENT AND MANAGEMENT BY DR AZHAR."— Presentation transcript:
DIFFICULT AIRWAY ASSESSMENT AND MANAGEMENT BY DR AZHAR
DEFFINATION American society of Anesthesiologist (ASA) suggested that when sign of inadequate ventilation could not be reversed by mask ventilation or oxygen saturation could not be maintained above 90% or if a trained Anaesthetist usinig conventional larangoscope takes more than 3 attempts or if a trained Anaesthetist usinig conventional larangoscope takes more than 3 attempts or more than 10 minute are required to complete tracheal intubation
Anatomy of oropharynex and larynx
PREVALENCE Fact of the matter is even with proper evaluation only 15 to 50 % were picked up while difficult face mask ventilation in general is about 1:10,000 out of which again 15% proved to be the difficult intubation,while incidence of extreme difficult or abandons intubation in general surgery patients are 1:2000 but in obstetrics is 1:300 and of course most critical incidence is Hypoxia
BASIC AIRWAY EVALUATION 1. Previous anaesthetic problems and general appearance of the patient. 2. Neck, face, maxilla and mandible with jaw movements. 3. Head extension and movements, teeth, oropharanx and soft tissue of the neck.
Why does it happens ? 1. Exaggerated idea of personal ability. 2. Not requesting for experienced help. 3. No discussion with colleagues about proposed management of the case. 4. Ill conceived plan (A) with no proper back up plan (B). 5. Even poorly conducted plan (A) or sticking extra time to the plan (A) other way delaying the rescue plan late. 6. Last not the least not involving surgical friends.
Anatomical factors affecting Larangoscopy 1. Short Neck. 2. Protruding incisor teeth. 3. Long high arched palate. 4. Poor mobility of neck. 5. Increase in either anterior depth or Posterior depth of the mandible decrease in Atlanto Occipital distance that's why role of Radiology has increased in our specialty
ASSESSMENT OF AIRWAY Mallampati classification with larangoscopic view. Patils Test
Measurement of Atlanto-Occepital Angle
MANAGEMENT PLAN OF ANTICEPATED DIFFICULT AIRWAY 1. Discussion with colleagues in advance. 2. Equipment tested before. 3. Senior help backup. 4. Definite initial plan (A) for ventilation and intubation. 5. Definite plan (B) than option of awake intubation. 6. Ideal situation surgery team standby.
UNEXPECTED DIFFICULT AIRWAY Problems 1. Unexpected encounter with difficult airway is mostly gone worse because mainly GA is already given including (NMB,S). 2. Equipment may not be in hand. 3. Senior and back up plan not available so delay occur in active resuscitation TECHNIQUE OF MANAGEMENT 1. Manipulation of the patients airway. 2. Laryngeal pressure. 3. Nasal or oral airway. 4. Different blades of larangoscope like Miller, Magill, Robershaw, Mackintosh and relatively new laryngoscope McCoy. 5. Bougies and stylet 6. LMA. 7. Combitube.
1 alternative 2 alternative 3 alternative 4 alternative 1 Manipulation of airway different blade, bugie 2 LMA, ILMA, Combitube 3 Trantracheal Jet Ventilation 4 Cricothireotomy, Tracheostomy
GALLERY OF TOOLS
Bullard laryngoscope Fiber optic
Mini Tracheostomy (Cont.)
BLIND NASAL, RETROGRADE AND HIGH FREQUENCY VENTILATION
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