1. Airway Management Anesthesia View
Andreas Grabinsky, MD
Assistant Professor, Dept. of Anesthesiology
Program Director and Section Head, Emergency & Trauma Anesthesia
Harborview Medical Center

2. Overview Airway management in the field
Airway management in the hospital
Indications
Priorities
Problems

3. OR Airway Management

4. Field Airway Management

5. In the OR

6. OR Setting 26 Operating rooms > 1.000 cases per month
13 Anesthesiology Attendings
26 Residents / CRNA’s
Start 07:30AM (Wednesday 08:30AM)
26 potential airways at 07:30AM

7. The OR Whiteboard

8. What to do ? Find the Anesthesiologist in charge
Find the anesthesiologist (covers 2-3 rooms)
Help out
Hope you “get the airway”
Stay in one of the rooms (first rotation)
Find a “late start room” for another airway (second rotation)

9. Learning Goals Identify difficult airway
Proficient bag/mask ventilation
Use of alternative airway techniques
Prepare Intubation
Learn about RSI
Demonstrate Laryngoscopy / Intubation

10. The Intubator

11. Airway Priorities
1. Oxygenate
2. Ventilate
3. Protect Airway

12. Use the least aggressive means necessary for airway management
Spontaneous ventilation
Assisted mask/bag ventilation
Controlled mask/bag ventilation
Intubation + controlled ventilation
Surgical airway + controlled ventilation
Use the least aggressive means necessary for airway management

13. Indications for Intubation
Insufficient Oxygenation
Insufficient Ventilation
Loss of airway protection
Impending airway problems (CNS, Trauma)

14. Preparation Oxygen Ambu bag with mask Suction Laryngoscope (working)
different size ETT
Plan B (Adjuncts)

15. Prevention of Failure Assess situation
Decision for specific airway management
Communicate
Plan B
Reassess (change plan, if needed)

16. Failure to intubate in the OR
Use alternative methods
Get help
Wake patient up

17. Failure to intubate in the Field
Use alternative methods
Failure is not an option !

18. Do not mess with a perfectly fine airway.
Prevention of Failure
Do not mess with a perfectly fine airway.

19. Publications

20. Airway Assessment

21. Difficult Airway

25. Harborview Specials

27. Indications for Intubation
Insufficient Ventilation
Insufficient Oxygenation
Loss of airway protection
Impending airway problems (CNS, Trauma)

28. Training

32. Preparation Oxygen Ambu bag with mask Suction Laryngoscope (working)
different size ETT
Plan B

34. Tools

35. Real Men use Miller Blades

42. i-gel

43. Res-Q-Scope

44. Glidescope

46. Glidescope

47. Glidescope 25 Paramedic students Glidescope versus Macintosh 3 blade
100 intubations in different scenarios on manekin
Significant better visualized glotic opening with Glidescope
Same success rate of 76%
Increased time to intubation with Glidscope
Aziz, Michael, Dillman, Dawn, Kirsch, Jeffrey R. and Brambrink, Ansgar(2009)'Video Laryngoscopy with the
Macintosh Video Laryngoscope in Simulated Prehospital Scenarios by Paramedic Students',Prehospital Emergency Care,13:2,251 —
255

48. Res-Q-Scope
22 US military parmedic (50 manekin and 8 human intubations)
22 Emergency medicine residents/attending
20 minutes instruction and 20 minutes training, 3 trials with each device
Intubation time Res-Q-Scope 25.9 seconds
Intubation time direct Laryngoscopy 14.6 seconds
Shawn M. Varney MD⁎, Melissa Dooley MD, Vikhyat S. Bebarta MD
Faster intubation with direct laryngoscopy vs handheld videoscope in uncomplicated manikin airways
American Journal of Emergency Medicine (2009) 27, 259–261

49. Questions ?