1. Intubation and Anatomy of the Airway

2. Anatomy
1)The Laryngoscope’s function is to visualise the mouth/Pharynx/Epiglotis
2)With ur left hand insert the Blade to the right of the tongue so that the tongue moves toward the left
3)Once the tip of the blade is at the base of the tongue pull the laryngoscope forward and upward in 45 digree from the horizontal line(don’t rotate as u might damage the upper teeth). 4)

3. Anatomy
1)The Laryngoscope’s function is to visualise the mouth/Pharynx/Epiglotis
2)With ur left hand insert the Blade to the right of the tongue so that the tongue moves toward the left
3)Once the tip of the blade is at the base of the tongue pull the laryngoscope forward and upward in 45 digree from the horizontal line(don’t rotate as u might damage the upper teeth). 4)

4. Anatomy
Compression to the cricoid cartilage can be applied in rapid sequence induction in order to compress the esophagus to prevent aspiration in cases of regurgitation but be wary in cases of vomiting as it may cause perforation of the esophagus
1)The Laryngoscope’s function is to visualise the mouth/Pharynx/Epiglotis
2)With ur left hand insert the Blade to the right of the tongue so that the tongue moves toward the left
3)Once the tip of the blade is at the base of the tongue pull the laryngoscope forward and upward in 45 digree from the horizontal line(don’t rotate as u might damage the upper teeth). 4)

5. Anatomy
1)The Laryngoscope’s function is to visualise the mouth/Pharynx/Epiglotis
2)With ur left hand insert the Blade to the right of the tongue so that the tongue moves toward the left
3)Once the tip of the blade is at the base of the tongue pull the laryngoscope forward and upward in 45 digree from the horizontal line(don’t rotate as u might damage the upper teeth). 4)

6. Anatomy
1)The Laryngoscope’s function is to visualise the mouth/Pharynx/Epiglotis
2)With ur left hand insert the Blade to the right of the tongue so that the tongue moves toward the left
3)Once the tip of the blade is at the base of the tongue pull the laryngoscope forward and upward in 45 digree from the horizontal line(don’t rotate as u might damage the upper teeth). 4)

7. Anatomy
1)The Laryngoscope’s function is to visualise the mouth/Pharynx/Epiglotis
2)With ur left hand insert the Blade to the right of the tongue so that the tongue moves toward the left
3)Once the tip of the blade is at the base of the tongue pull the laryngoscope forward and upward in 45 digree from the horizontal line(don’t rotate as u might damage the upper teeth). 4)

8. Indication for endotracheal intubation
For supporting ventilation in patient with some pathologic disease
: Upper airway obstruction
: Respiratory failure
: Loss of conciousness or a Glasgow coma scale of less then 8

9. Indication for endotracheal intubation (con’t)
For supporting ventilation during general anesthesia
Type of surgery
: Operative site near the airway
: Abdominal or thoracic surgery

10. Indication for endotracheal intubation (con’t)
: Prone or lateral position
: Long period of surgery
: Patient has risk of pulmonary aspiration
: Difficult mask ventilation

11. AIRWAY ASSESSMENTS
Conditions that are associated with difficult intubation
: Congenital anomalies ---> Pierre Robin syndrome , Down’s syndrome
: Infection in airway--> Retropharyngeal abscess, Epiglottitis
: Tumor in oral cavity or larynx

12. AIRWAY ASSESSMENT
Condition that associated with difficult intubation (con’t)
Enlarge thyroid gland
trachea shift to lateral or compressed tracheal lumen

13. AIRWAY ASSESSMENT
Condition that associated with difficult intubation (con’t)
: Maxillofacial ,cervical or laryngeal trauma
: Temperomandibular joint dysfunction
: Burn scar at face and neck
: Morbidly obese or pregnancy

14. Why we should asses a patient’s airway preoperatively
Why we should asses a patient’s airway preoperatively ? The goal of evaluating a patient's airway
is to identify any possible problems with maintaining, protecting, and providing a patent airway during anesthesia.
The evaluation is performed with the aid of a physical examination and a review of the patients history and previous anesthetic records.
1)The Laryngoscope’s function is to visualise the mouth/Pharynx/Epiglotis
2)With ur left hand insert the Blade to the right of the tongue so that the tongue moves toward the left
3)Once the tip of the blade is at the base of the tongue pull the laryngoscope forward and upward in 45 digree from the horizontal line(don’t rotate as u might damage the upper teeth). 4)

15. 1-2-3’ test ‘1-2-3’ test components: TMJ mobility Mouth opening
1-2-3’ test is used to asses several factors that may affect decisions concerning the patient’s airway management.
‘1-2-3’ test components:
TMJ mobility
Mouth opening
Thyromental distance

16. temporomandibular joint (TMJ) mobility
1-2-3’ test
First component :is
temporomandibular joint (TMJ) mobility
It`s used to identify and restricted mobility of the temporomandibular joint (TMJ). Ask the patient to sit up with his head in the neutral position and open his mouth as wide as possible.The condyle should rotate forward freely such that the space created between the tragus of the ear and the mandibular condyle is approximately one fingerbreadth in width.

17. Mouth Opening and tongue protrusion:
1-2-3’ test
Second component :is
Mouth Opening and tongue protrusion:
Incisor gap : normal -> more than 3 cms or the patient's mouth should allow at least 2 fingers between the teeth, on the other hand, It will be difficult to insert the laryngoscope blade on less than 2 fingers

18. Mouth Opening and tongue protrusion:
1-2-3’ test
Second component :is
Mouth Opening and tongue protrusion:
With the patient's tongue maximally protruded, the structures visualized should include:
The pharyngeal arches.
Uvula.
Soft palate.
Hard palate.
Tonsillar beds.
Posterior pharyngeal wall.
Technical difficulties with intubation should be anticipated when only the tongue and soft palate are visualized in a patient during this above maneuver.

19. Mouth Opening and tongue protrusion:
1-2-3’ test
Second component :is
Mouth Opening and tongue protrusion:
Mallampati Classification
Actually, the amount of the posterior pharynx you can visualize is important and correlates with the difficulty of intubation.  Visualization of the pharynx is obscured by a large tongue (relative to the size of the mouth), which also interferes with visualization of the larynx on laryngoscopy.

20. 1-2-3’ test Second component : Mouth opening and tongue protrusion
Mallampati classification is used to predict the ease of intubation
It is determined by looking at the anatomy of the oral cavity; specifically, it is based on the visibility of the base of uvula, faucial pillars(the arches in front of and behind the tonsils) and soft palate. Some suggest that phonation is best to be used to better asses the mallampati score
Modified Mallampati Scoring is as follows: Class 1: Full visibility of tonsils, uvula and soft palate Class 2: Visibility of hard and soft palate, upper portion of tonsils and uvula Class 3: Soft and hard palate and base of the uvula are visible Class 4: Only Hard Palate visible

21. Class 3,4 -> may be difficult intubation
Uvula

22. AIRWAY ASSESSMENT Laryngoscopic view
grade 3,4 -> risk for difficult intubation

24. The thyromental distance :
1-2-3’ test
Third component :is
The thyromental distance :
It is measured from the lower border of the chin.
Adults who have less than 3 fingerbreadths between their mentum and thyroid notch may have either an anterior larynx or a small mandible, which will make intubation difficult.

25. The thyromental distance :
1-2-3’ test
Third component :is
The thyromental distance :
Next, evaluate the mobility of the cervical spine. This is performed by asking the patient to flex and extend their neck. They should be able to perform this without discomfort. Disease of the C-spine (RA, OA, previous injury or surgical fusion) may limit neck extension, which may create difficulties during attempts to intubate. This is certainly true if the atlanto-occipital joint is involved, as restriction of this joints mobility may impair one's ability to visualize the larynx.