ASA difficult Airway Guidelines Flashcards
1
Q
Evaluation of Airway : what 2 main areas for airway evaluation?
A
- Risk assessment to predict a difficult airway or risk of aspiration.
- Airway examination
2
Q
Airway evaluation: what relevant focused anaesthetic history would you ask?
A
Previous diffult airway
Prior surgical airway
Review anaesthetic chart
3
Q
Airway evaluation: what relevant focused medical history would you ask?
A
Syndromes : Downs, klippel-feil, crainiofascial
Medical : diabetes mellitus, RA,
4
Q
Airway evaluation: what relevant focused surgical history would you ask?
A
Facial burns
Submandibular/ rwtropharengial abscesses
Thyroid
Mediastinal mass
5
Q
Airway evaluation: what relevant focused physical exam would you perform
A
- Look externally
- Mallampati score
- Measure thyromental distance, sternomental distance, hyomental, interincisor distance, hyomental distance ratio, neck circumference
6
Q
What is the acceptable mouth opening
A
7
Q
Which conditions would affect mouth opening?
A
8
Q
What is mallampati scoring and grades
A
9
Q
What’s is modified mallampati score?
A
10
Q
What does the mnemonic BONES stand for?
A
Beard Obese No teeth Elderly Snoring
11
Q
What does the mnemonic LEMONS stand for?
A
Look externally Examine 3:3:2 Mallampati Obstruction Neck mobility Surgical rescue ease
12
Q
What are the for Ds in airway assessment?
A
Distortion
Disproportion
Dysmobility
D
13
Q
What are the ASA recommendations on airway evaluation?
A
- Before the initiation of anaesthetic careor airway management, ensure that an airway risk assessment is performed by the person responsible for airway management whenever feasible to identify patient, medical, surgical, environmental, and anaesthetic factors I. E risk of aspiration that may indicate the potential for difficult airway.
- Before the initiation of anesthetic care or airway management, conduct an airway physical examination.
14
Q
What are the core steps to prepare for difficult airway?
A
- Equipment availability
- Informing patient of potential difficulty
- Preoxygenation
- Patient positioning
- Sedative admin
- Local anaesthesia
- Supplimental oxygen
- Patient monitoring
- Human factors
15
Q
Which equipment should be prepared for difficult airway?
A
16
Q
Aim and end point of preoxygenation
A
17
Q
What is apneoic oxygenation?
A
18
Q
What is the ideal position of patient with diffult airway?
A
19
Q
What monitoring is required during airway management?
A
20
Q
What are the 3 ASA recommendations on preparation for difficult airway management?
A
- If a difficult airway is known or suspected, ensure that a skilled individual is present or immediately available to assist with airway management. 17494*5001 2b.
- If a difficult airway is known or suspected, inform the patient or responsible person of the special risks and procedures pertaining to management of the difficult airway. 17474*21311 2c.
- If a difficult airway is known or suspected, administer oxygen before initiating management of the difficult airway and deliver supplemental oxygen throughout the process of difficult airway management, including extubation.
21
Q
What are the standards of difficult airway
A
22
Q
What are the options of Airway management for an anticipated difficult airway?
A
Awake tracheal intubation
Awake tracheostomy
Anaesthetised trachy/ET
23
Q
What airway maneuver can be used in difficult airway
A
Backward-upward-rightward pressure
Cricoid pressure
24
Q
Which none invasive airway device can be used?
A
Laryngoscopy blades Adjuncts : introducer, bougie, stylet Video Laryngoscopy Flexible intubation scopes Rigid bronch
25
What is the combination technique in difficult airway management?
1. Direct/ video laryngoscopy with optic or video stylet, flexible scope, airway exchange catheter, retrograde placed guidewire,
2. supraglottic with optic or video stylet or flexible scope
26
Which invasive airway intervention
Retrograde wire guided
Front of neck percutaneous cricothyrotomy
Surgical cricothyrotomy
ECMO
27
What is the role of ECMO in difficult airway?
28
How is awake intubation performed?
29
Management strategies for adequate BMV but difficult intubation?
30
Management strategies for can't ventilate can't intubate?
31
Alternative approaches to airway management?
32
Recommendation for anticipatex difficult airway
dentify a strategy for (1) awake intubation, (2) the patient who can be adequately ventilated but is difficult to intubate, (3) the patient who cannot be ventilated or intubated, and (4) alternative approaches to airway management failure.
33
When appropriate, perform awake intubation if the patient is suspected to be a difficult intubation and difficult ventilation (face mask/supraglottic airway) is anticipated. 16568*22721 4b. When appropriate, perform awake intubation if the patient is suspected to be a difficult intubation and increased risk of aspiration is anticipated. 1654230*15112 4c. When appropriate, perform awake intubation if the patient is suspected to be a difficult intubation and anticipated to be incapable of tolerating a brief apneic episode. 1664434*1462 4d. When appropriate, perform awake intubation if the patient is suspected to be a difficult intubation and difficulty with emergency invasive airway rescue is anticipated.
34
5. If a noninvasive approach is selected, identify a preferred sequence of noninvasive devices to use for airway management. 16663*29701 5a. If difficulty is encountered with individual techniques, combination techniques may be performed. 16766*28511 5b. Be aware of the passage of time, the number of attempts, and oxygen saturation.16691*6201 5c. Provide and test mask ventilation between attempts.16758*231361 5d. Limit the number of attempts at tracheal intubation or supraglottic airway placement to avoid potential injury and complications.
35
If an elective invasive approach to the airway (e.g., surgical cricothyrotomy, tracheostomy, or large-bore cannula cricothyrotomy) is selected, identify a preferred intervention. 16572*21611
6a. Ensure that an invasive airway is performed by an individual trained in invasive airway techniques, whenever possible. 16683*15201
6b. If the selected invasive ainvasive approach fails or is not feasible, identify an alternative invasive intervention.
36
• Call for help. • Optimize oxygenation.∥∥∥∥
• When appropriate, refer to an algorithm#### and/or cognitive aid.
• Upon encountering an unanticipated difficult airway:
◦ Determine the benefit of waking and/or restoring spontaneous breathing.
◦ Determine the benefit of a noninvasive versus invasive approach to airway management.
◦ If a noninvasive approach is selected, identify a preferred sequence of noninvasive devices to use for airway management.*****
▪ If difficulty is encountered with individual techniques, combination techniques may be performed.
▪ Be aware of the passage of time, the number of attempts, and oxygen saturation. ▪ Provide and test mask ventilation after each attempt, when feasible.
▪ Limit the number of attempts at tracheal intubation or supraglottic airway placement to avoid potential injury and complications. • If an invasive approach to the airway is necessary (i.e., cannot intubate, cannot ventilate), identify a preferred intervention.††††† ◦ Ensure that an invasive airway is performed by an individual trained in invasive airway techniques, whenever possible.
◦ Ensure that an invasive airway is performed as rapidly as possible. ◦ If the selected invasive approach fails or is not feasible, identify an alternative invasive intervention. ▪ Initiate ECMO when/if appropriate and available.
37
Algorithm for difficult airway.
38
Confirmation of tracheal intubation?
• Confirm tracheal intubation using capnography or endtidal carbon dioxide monitoring. • When uncertain about the location of the tracheal tube, determine whether to either remove it and attempt ventilation or use additional techniques to confirm positioning of the tracheal tube.‡‡‡‡
39
Extubation recommendation
Have a preformulated strategy for extubation and subsequent airway management. 13. Ensure that a skilled individual is present to assist with extubation. 14. Select an appropriate time and location for extubation when possible. 15. Assess the relative clinical merits and feasibility of the short-term use of an airway exchange catheter and/or supraglottic airway that can serve as a guide for expedited reintubation. 16. Before attempting extubation, evaluate the risks and benefits of elective surgical tracheostomy. 17. Evaluate the risks and benefits of awake extubation versus extubation before the return to consciousness. 18. Assess the clinical factors that may produce an adverse impact on ventilation after the patient has been extubated.
40
Follow up recommendations
Inform the patient (or responsible person) of the airway difficulty that was encountered to provide the patient (or responsible person) with a role in guiding and facilitating the delivery of future care. 20. Document the presence and nature of the airway difficulty in the medical record to guide and facilitate the delivery of future care.
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42
43
Way are the relevant human factors in airway management?
44
Difficult airway info gram pediatric
45
Difficult airway infograph adults
46
ASA Pediatric difficult airway algorithm
47
ASA adults difficult airway algorithm
