Airway Flashcards
Indications for Intubation
Airway protection Maintenance of patent airway Application of positive pressure ventilation Maintenance of adequate oxygenation Deliver predictable Fio2 Provide positive end-expiratory pressure
Indications for a Mask Case
No instrumentation of airway required
Therefore will avoid trauma, CV stimulation
Difficult airway not present
Surgeon does not need access to head/neck (BMT-ok)
No airway bleeding/secretions
Case of short duration
No table position changes- head available
Ventilation by mask requires the ability to achieve a seal between the mask and face to overcome upper airway obstruction. Obstruction should be easily relieved with airway/ chin lift
Medical History co morbidities that may affect your airway management
Lesions of larynex Thyroid disease Cancer GERD Diabetes Sleep Apnea Obesity Genetic Disorders Rheumatoid Arthritis Musculoskeletal Scleroderma
What surgical history may effect the airway management?
Tracheostomy or scar
Neck Dissection
UVPP
Cervical Neck Instrumentation (fusion)
Airway Assessment:The Physical Exam
General appearance
head
neck-size circumference + length
presence of heavy facial hair
Mouth- lips, gums, tissues
Teeth
length of incisors
condition of teeth- missing, protrusions, overbite
relationship of upper incisors (maxillary) to lower incisors (mandible)
dentures/bridges out?
Mouth opening
Normal > 4cm or >2 fingerbreadths
Size & mobility tongue
Size & shape mandible; maxillary overgrowth
TMJ
Thyromental distance
Distance from mandible to prominence of thyroid cartilage (thyro-mental) normal 6.5 cm (50 mm); 3 fingerbreadths (3FB)
Hyoidmental distance
Distance hyoid to mandible (hyoid-mental) normal 2FB
Cervical Range of Motion-atlanto-occipital joint
Listen to BBS/ upper airway sounds for snoring, stridor
Mandibular protrusion test
A: lower incisors can be protruded anterior to the upper incisors
B: The lower incisors can be brought edge to edge with upper incisors
C. The lower incisors cannot be brought edge to edge with upper incisors
Mallampati Exam
Mallampati Classification I-IV
Relates the size of base of tongue to the oral cavity
Visualization pharyngeal structures- soft palate, fauces, uvula, and pillars
During this assessment the patient is seated upright with the head in neutral position. The patient is asked to open the mouth as wide as possible and to stick out the tongue.
Patients encouraged NOT to phonate or say “ahh”, as phonation can inappropriately elevate the soft the palate.
Mallampati Exam Classes and what can you see?
Class I: entire uvula, pillars, faces, soft/hard palate
Class II: uvula, facuse, soft/hard palate
Class III: base of uvula, soft/hard palate
Class IV: Hard palate only
What are some strong predictors of a difficult airway?
Obesity Decreased head and neck movement Decreased jaw movement Receding mandible “buck teeth”
Airway setup
Laryngoscope /Blades 2 types Oral/nasal airways several sizes Tongue depressor ET Tubes 2 sizes w/stylets and syringe on cuff Suction Ambu-bag LMA
What will you document?
Preop-
dental, cervical range of motion, Mallampati class, TM distance, mouth opening
Post-intubation
visualization, trauma, equipment used, hemodynamic or respiratory changes
Post-extubation
loose teeth intact, airway patency, adjuncts airway maneuvers used
