1. The Difficult Airway
The Big Sweat

2. Causes of Difficult Airway
“Normal”
Infections
Trauma
Endocrine
Foreign Body
Inflammatory
Tumours
Congenital
Pregnancy

3. Infections
Epiglottitis
Abscesses
Croup
Viral- papillomatosis

4. Papillomatosis of Larynx

5. Epiglottitis

7. Trauma Surgical Previous distorting surgery Displacement
Haemorrhage and
haematoma
Cervical spine
The injury.
Treatment of the injury.
Laryngeal
Stings.
Burns

8. Neck Trauma

9. Neck Trauma- Endoscopic

10. Endocrine
Obesity
Diabetes mellitus
Myxoedema etc
Acromegaly.

11. Obesity

12. Foreign body
Associated conditions eg alcohol
Inflammatory response

13. Foreign Body

14. Foreign Body

15. Inflammatory
Ankylosing Spondylitis
Rheumatoid arthritis

16. Ankylosing Spondylitis

17. Tumours Benign or malignant Simple cysts of epiglottis
Extrinsic tumours Tongue esp lingual tonsil.
Tonsil
Pharynx
Thyroid
Thymus
Mediastinum
Intrinsic Larynx
Trachea

18. Tumour of Larynx- Cyst

19. Lymphoma of Larynx

20. Carcinoma of Larynx

21. Congenital Choanal atresia Trachaeomalacia Cleft Palate Pierre-Robin
Treacher-Collins.
Hallerman –Streiff.
Fibroplasia Ossificans Progressiva
? Ankylosing Spondylitis

29. F.O.P

30. Pregnancy
Fear
Breasts
Fluid retention

31. Breasts

32. History
Snoring.
Can sleep supine?
Previous anaesthesia
Notes!

33. Examination Physical Jaw Maxilla Teeth Beard Mouth opening
Neck movements
Mallampatti
Thyro-mental distance
Atlanto-occipital joint distance

34. Teeth

35. Mallampatti

36. Upper Lip Bite Test Tests movement of mandible on maxilla
Class1 Upper lip mucosa can be completely obscured by lower incisors
Class2 Upper lip mucosa partially obscured
Class3 Upper lip mucosa not obscured at all.

37. Thyromental distance- Patil Distance
Extend neck
Measure from thyroid notch to lower mandible in mid-line
If less than 6cm, then laryngeal axis makes more acute angle with pharyngeal axis. This may make alignment more difficult with less room for the tongue

38. Sternomental Distance
12.5cm

39. Inter-Dental Distance
2.5 Cm or less

40. Atlanto-Occipital Joint Distance
“Normal” angle is 35 degrees. The bigger the angle, the more extension of the neck.

41. Examination Radiology Lateral views
Special views for atlanto-occipital joint
Swimmer’s view.

42. Examination
Endoscopic
Rigid Direct
Indirect
Fibrescopic
Nasal
Oral

43. Laryngoscopic View

44. Usefulness of Difficult Airway Predictability
All refer to direct laryngoscopy
High degree of specificity
Poor sensitivity. Meta-analysis of 50,000- may only predict up to 20% of difficult airways

45. Aids to Difficult Intubation
Position
Pillow
Assistant!

47. Aids Laryngoscopes. Long blades. McCoy Flexiblade Dorges. Prism
Video-Intubating Laryngoscope
X-Lite video set.

48. McCoy

49. McCoy

50. Viewmax

51. Airtraq

52. Video-Intubating laryngoscope

53. Video-intubating laryngoscope

54. McGrath

55. Endotracheal Tube Guides
Eschmann Trachael Introducer ( gum elastic bougie)
Frova Intubating Introducer. Has two side ports, hollow lumen and stiffening cannula.
Arndt Airway Exchange Catheter Set. Can be used to facilitate LMA/ETT change. Has multiple side ports and fits bronchoscope
Aintree Airway Exchange Catheter.
V.E.T.T.

56. Visualised Endotracheal Tube
Standard tube with image and light transmission fibres placed in the wall.
Images are conveyed to an attached video-monitoring system

57. V.E.T.T.

58. Lighted Stylets Trachlight Seeing optical Stylet System
Bonfils Retromolar Intubation Fibrescope

59. Trachlight

60. Bonfils Retro-molar Intubating Stylet

61. Seeing Optical Stylet

62. Indirect Rigid Fibreoptic Laryngoscopes.
Rugged.
Good control of soft tissue.
Better secretion management
Portable.
Bullard Elite. Attachable metal stylets. Working channel for oxygen/suction/LA
UpsherScope. Simpler.
WuScope

63. Bullard Rigid Laryngoscope

64. UpsherScope

65. UpsherScope in Use

66. Wuscope

67. Supraglottic Ventilatory Devices
Laryngeal Mask Airway
Ordinary Now in ASA
algorithm.
Proseal
Intubating LMA Fast-trach
LMA C-trach
Laryngeal Tube.
Suction Laryngeal Tube
SLIPA
Pharyngeal Airway Xpress
Glottic Aperture Seal Airway- foam
Combitube

68. Proseal

69. Laryngeal Tube

70. Pharyngeal Airway

71. SLIPA Streamlined Liner of Pharyngeal Airway
A cuffless pre-shaped sealer

72. Combitube

73. Combitube

74. Special Airway Techniques
Intubating LMA
Flexible Fibreoptic Intubation
Retrograde Intubation
Transtracheal Jet Ventilation
Cricothyrotomy.

75. Intubating LMA- Fast-trach

76. C-trach

77. Cook Airway Exchange Catheters
Has lumen and side-vents- Oxygen insufflation
Can be attached to standard connector for IPPV.
Can be used to ventilate/insufflate
Can be left in situ.

78. Transtrachael Jet Ventilation

79. Cricothyrotomy Needle cricothyrotomy.
Percutaneous cricothryotomy- Seldinger
Surgical cricothyrotomy
Trachaeostomy
Translaryngeal trachaeostomy

80. Algorithms
ASA
Assoc Anaesthetists

81. ASA Algorithm Part 1

82. ASA Algorithm Part 2

83. ASA Algorithm with LMA

84. Relax