1. Jutarat Luanpholcharoenchai
Airway management
Jutarat Luanpholcharoenchai

2. Topic modules Anatomy of airway Evaluation of airway Airway equipments
Intubation & ventilation techniques
(-> W : Airway Management)

3. Respiratory tract
UPPER TRACT

4. Anatomy of larynx

5. Trachea& Lungs
Trachea : Adult cm , Newborn 4 cm Right mainstem : larger, shorter and less angle Endobronchial intubation RUL atelectasis

6. Evaluation of airway
History
Physical examination

7. History Disease & Underlying disease mass/ tumor infection trauma
contracture
obesity
Congenital& variation

8. History History of previous anesthesia general anesthesia
history of difficult intubation

9. Physical examination
Airway examination
Airway investigation

10. Airway examination General contour Oral cavity Inter incisor distance
Mallampati classification
Thyromental distance
Neck circumference
Range of motion of neck

11. Mallampati classification
Laryngoscopic view

12. Difficult intubation Suspected inter incisor < 3 cm TMD < 6 cm
Mallampati class >3
neck circumference > 40 cm
limited TM joint or neck AO axis movement

13. Investigation
X-ray
Neck
Chest CT

14. Airway Equipments Artificial airway devices
: supraglottic airway & endotracheal tube
Anesthesia mask
Laryngoscope
etc……..

15. Artificial airway Endotracheal tube Orotracheal tube Nasotracheal tube
Double lumen tube
Semirigid tube :armored, anode tube
RAE tube
Supraglottic airway
LMA (laryngeal mask airway)
Laryngeal tube
Oropharyngeal /
nasopharyngeal airway

16. Endotracheal tube Less mucosal damage Sore throat Aspiration
Spontaneous extubation
More mucosal damage!

17. Endotracheal tube Nasotracheal tube Cuff RAE tube Double lumen tube
Uncuff

18. Endotracheal tube sizes
Age
Internal diameter
(mm.)
Length
(cm.)
Full term child
3.5
10-12
Child
Age(yr)/4 +4
Age(yr)/2 +12
Adult
-Female
-Male
20-22
21-24

19. Supraglottic airway
LMA
LARYNGEAL TUBE

20. Oral airway: oropharyngeal airway
Vomitting Gag reflex
Airway obstruction!!!

21. Nasal airway : nasopharyngeal airway
Too long enter esophagus
Mucosal injury/bleeding
Better tolerance

22. Anesthesia mask

23. Rigid laryngoscope Bulb Curve blade “Macintosh” Electrical contact
Handle
Straight blade

24. Lever-Tip Laryngoscope Blade

25. Etc…..
Self inflating bag
stylet

26. Intubation & ventilation techniques

27. Indications for Definitive Airway
Airway Protection
Ventilation
1.Unconscious
1.Apnea
Neuromuscular Paralysis
Unconscious
2.Severe Maxillofacial fracture
2.Inadequate Respiratory Effort
Tachypnea
Hypoxia or Hypercarbia
3.Risk for aspiration
Bleeding
Vomiting
3.Severe closed head injury with need for hyperventilation
4.Risk for obstruction
Neck hematoma
Laryngeal, tracheal injury/burn

28. Equipments for endotracheal intubation
Rigid laryngoscope
Endotracheal tube
Anesthesia mask
Airway : oral, nasal
Syringe 10 cc
Stylet
Suction
Stethoscope
Anesthesia machine, breathing system ,self inflating bag
Monitoring : pulse oximeter, capnograph
Other : Plaster, lidocaine jelly

29. Techniques for routine intubation
Preoxygenation with 100% oxygen
Administration of induction agent
Loss of eyelash/verbal reflex
Mask ventilation
Administration of neuromuscular block
Intubation
Confirm ETT in trachea

30. Airway maneuvers
Head-tilt chin-lift
Jaw-thrust maneuver

31. Face mask ventilation One hand two hand
the two-hand mask hold is most effective
KEYS SUCCESS a patent airway
an adequate mask seal
proper ventilation

32. Sniff position
10 cm.

33. Intubation Techniques
Valeculla

34. Complication of intubation
During laryngoscope & intubation
Malpositioning : esophageal intubation
Airway trauma : injury to tongue, lip etc.
Physiological reflexs : hypoxia, HT, tachycardia, laryngospasm
Tube malfunction : cuff perforation
While tube is in place
Malpositioning :bronchial intubation
Airway trauma : injury to mucosa
Tube malfunction : obstruction
Following extubation
Airway trauma : hoarseness, edema/stenosis of subglottic, trachea
Negative pressure pulmonary edema
laryngospasm

35. Questions ?