Airway Management Flashcards
Why is airway management so important?
30% of anaesthesia deaths are due to airway difficulties (not that uncommon)
2% are difficult intubations - may take a couple of attempts
Failed intubations are quite common
What population are very difficult to intubate?
Pregnant women having emergency sections
What is included within an airway assessment?
History - General (any problems) plus anaesthetic history (any previous problems)
Notes
Examination
What conditions can make airways challenging?
Obesity
Pierre-robin syndrome, Down’s syndrome
Diseases - RA, ankylosing spondylitis, acromegaly.
Surgical procedures changing anatomy.
Emergency surgery (less assessment), RSI (not fasted or acute abdomen - no bagging - cricoid pressure), burns, pregnancy, diabetes.
Previous difficulty intibating
Cervical spine imobility
Reduced functional respiratory reserve.
What features make RSI intubation more challenging?
Speed - not wanting to aspirate contents
Reduced opportunity for assessment
No bagging - less reserve
Cricoid pressure
What is involved in the examination part of the anaesthetic assessment?
What manouvers are done to assess this?
General appearance - body habitus, facial hair, masses, scars, strong or weak chin.
Mouth opening (Stick out tongue - three fingers in mouth vertically) + Mallampati (Score 1-4)
Jaw movement (Bottom teeth under top teeth)
Neck length and movement (Lift head up and down)
Dentition - dentures to take out, caps or crowns, wobbly teeth (Consent for damage to teeth)
What is the Mallampati score based on?
How much you can see on mouth opening with tongue out?
1 - Whole uvula (Easy)
2
3
4 - No uvula (Hard)
What are the typical steps for plan A B C D for difficult intubation?
A - ETT Tube successfully inserted
B - I-gel airway
C - Bag mask and valve and wake up (can’t wake if emergency)
D - Front of neck
Voice unless in routine theatre
What guidelines should be followed for difficult intubation?
DAS - Difficult intubation guidelines
(ABCD)
What grading system do you use to describe to use the view on a direct laryngoscope?
Grade 1-4
Grade 1 - Full view of cords
Grade 2 - Partical view of cords
Grade 3-4 , No view of cords (Bougie required)
Video-laryngoscope can be used - 1st line in COVID
When might awake fiberoptic intubation be used?
Severe cases e.g. NO neck flexion
They can stay awake to maintain own airway if you have limited secondary options
Need to anaesthetise their aiway
When might an Emergency FONA be required?
Rarely - Plan D (Unless you can’t do other stages)
If it is not possible to intubate or wake up a patient.
Scalpel, bougie, insert airway.
