AIRWAY MANAGEMENT

BY Dr.VARUN MENON .P PG Student Department Of OMFS

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Anatomy of the Airway Evaluation of the Airway Airway Algorithm Basic Airway Management Advanced Airway Management

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velopharynx (posterior to the soft palate) and retroglossal oropharynx (posterior to VARUN MENON P 3 the base of the tongue).

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nasal cavity 11 cm long from nostril to choana surface area of approximately 160 cm2 Larynx 3rd to 6th cervical vertebra In adults it is 35-45 mm long and has a diameter of 25-35 mm.

Batlh~re's Chmcal Anaesthestology- 213 Vol 9, No 2, June

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Airway Management
three phases: airway evaluation Actual management of the airway (i.e. mask ventilation, laryngoscopy and endotracheal intubation) extubation of the airway.

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Airway evaluation
Mallampati classification thyromental distance sternomental distance maximum vertical opening (MVO)

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Mallampati score

In a class I airway the soft palate, fauces, uvula, and tonsillar pillars are visible; in class II the soft palate, fauces, and uvula are visible; in class III the soft palate and base of uvula are visible; and in class IV only the hard palate is visible

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Thyromental distance
Ability to displace tongue during DVL Marker of mandibular space available 6.5cm or less retrognathia or short neck 3 finger breadth ideal

Thyromental distance. Ruler measurement from thyroid cartilage to menton of 25-03-2013 VARUN MENON P 17 mandible

Thyromental distance. Finger measurement from top of thyroid cartilage to menton of mandible
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Sternomental distance
Head and neck mobility < 12. 5 cms sniffing position difficult to attain

Sternomental top of sternal notch to menton of mandible. 25-03-2013 distance. Ruler measurement from VARUN MENON P

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MVO Inter incisal distance < 30 cm Trismus ,TMJ disorders other factors- obesity Decreased functional residual capacity Desaturates oxygen stores rapidly Difficulty with mask ventilation Decreased Posterior airway space
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 Predictors of Difficult Mask Ventilation Age over 55 years Body mass index exceeding 26 kg/m2 Presence of a beard Lack of teeth (edentulous) History of snoring

Source: Anesthesiology 2000; 92: 1229

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Elevation of head about 10cm

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Head Extension at atlanto occipital joint

Sniffing position

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Cormack & Lehanae grading of laryngoscopic views

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Conventional Laryngoscopes Macintosh type laryngoscopes (curved blades) Miller type laryngoscopes and other straight blade designs McCoy laryngoscope and variants (articulating tip) Rigid Fiberoptic Laryngoscopes Bullard laryngoscope Upsher laryngoscope Wu laryngoscope (WuScope) Video Laryngoscopes (with microminiature TV camera) GlideScope Video Laryngoscope Storz Video Laryngoscope Weiss Video Laryngoscope
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RAE (Ring, Adair, and Elwyn) tube)

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McCoy Laryngoscope with an articulating tip that can be used to lift a big epiglottis out of the way.
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The Thompson video laryngoscope (not yet commercially available)with a built-in video display
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Source: Anaesthesia 59 (4), 410-410.

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Light wand

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Cricothyroid membrane 1.5- 2cm in width & 2- 3 cm below laryngeal prominence

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12-14 gauge needle

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TRACHEOSTOMY

Trachea 2.3cm wide 1.8 cm deep in anterior posterior directions

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Fenestrated Tracheostomy tubes allows the patient to breathe through the fenestration
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First potrayed by BRASAVOLA

1.5 cm horizontal incision half way btwn cricoid cartilage and sternal notch

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Percutaneous Tracheotomy

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Percutwist set

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Retrograde intubation
first described by waters in 1963

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Submental intubation

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By Hernadez Altemir in 1986

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1.5 cm incision right anterior submental region parallel to inferior border of mandible
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