Airway Flashcards
What is the treatment of laryngospasm?
- Removal of airway irritants
- Deepen anaesthesia (Propofol)
- CPAP
- Paralysis
What are predictors of difficult BVM?
OBESE MM
Obese
Beard
Elderly
Snoring/OSA
Edentulousness
Mallampati 3 or 4
Male
What are pre-op issues with patients having laryngeal surgery?
- Assess lesion location, size, extent and mobility (imaging, nasendoscopy)
- Assess for obstruction - signs, symptoms, positioning
- Feasibility of laryngoscopy and intubation
- Consideration of backup plan
What are induction/intra-operative issues with patients having laryngeal surgery?
- consider antisialogogue
- consider use of topical local anaesthetics
- ensure all equipment is ready before induction
- Consider TIVA as maintenance with remi
- Consider airway devices i.e MLT, Jet ventilation, spont vent GA
What are post-operative issues with patients having laryngeal surgery?
- Laryngospasm
- Aspiration
- Airway obstruction due to oedema (give dexa, can give nebulised adrenaline if stridor)
What are signs of airway trauma?
- Subcut emphysema
- Dyspnoea
- Stridor
- Inability to tolerate the supine position
Minor signs:
- Local swelling and tenderness
- Hoarse voice
- Dysphagia
- Haemoptysis
What is the classification of laryngeal injuries?
Schaefer’s classification most commonly used:
- Minor endolaryngeal haematomas or lacerations, without detectable laryngeal fractures
- Laryngeal oedema or haematoma, or minor mucosal disruption without exposed cartilage
- Massive oedema, large mucosal lacerations, exposed cartilage, displaced fractures, and vocal cord immobility
- As per group 3 but with comminuted or unstable fractures
What is the management of laryngeal injuries?
- Schaefer class 1: Observation
- Other classes:
- Surgical tracheo under local
- Oral ETT under GA
- Awake fibreoptic intubation
What is the technqiue of awake fibreoptic intubation?
- Patient sitting up at 45 degrees, operator facing patient
- Nasal easier than oral
- Glyco 200mcg - 10 min prior
- Sedation (Prop TCI or Remi)
- Topicalising agent:
- calculate total amount of lignocaine you can use (~8mg/kg)
What are risk factors for difficult intubation?
Patient:
- Previous difficult intubation
- Arthritis
- Congenital disorders
- Obesity
Pathology:
- Infections
- Tumours
- Iatrogenic eg radiation
- Trauma
Surgery:
- Emergency
- Obstetric patients
What are signs on examination for difficult intubation?
LEMON
L - Look - obvious deformity, large teeth, limited mouth opening, macroglossia, C-spine collar
E - Evaluate - TMD <3 fingers
M - Mallampatti score
O - Obstruction i.e tumour, OSA
N - ROM, circumference
What are the fasting guidelines for adults?
- Clear fluids up to 2 hours pre op
- Solid food 6 hours
What are the fasting guidelines for children (over 6 months)?
- Clear fluids up to 1 hour pre op
- Breast milk 4 hours
- Food/formula 6 hours
What are the fasting guidelines for infants under 6 months?
- Clear fluids 1 hour preop
- Breast milk up to 3 hours
- Formula up to 4 hours
What are recommendations for aspiration management and prevention?
- All patients must be assessed before surgery
- Airway management should be consistent with the risk
- RSI is the technique for airway protection
- Cricoid must be done properly
Mx:
- Suction trachea once airway is secured, ideally before PPV is commenced
- CXR (may show RLL collapse/consolidation)
- Early bronch can be considered
- Early antibiotics not indicated (may increase ABx resistance)