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Dr Lim Yvonne
Consultant Anesthesiologist
M.B,B.S; M.Med(Anesth)
Airway Management:
Is it really a problem?
Difficult
Airways
Mallampati Classification
Airway Management:
Is it really a problem?
Cricoid Pressure
Definitions
Difficult Airway
Trained anesthesiologist experiences difficulty with mask
ventilation, difficulty with tracheal intubation, or both
Difficult Ventilation
Require 2 persons effort
Use of an oropharyngeal and/or nasopharyngeal airway
Practice Guidelines for Management of the Difficult Airway. ASA Task for
on Difficult Airway Management. Amended 2002.
Difficult Ventilation
Difficult Intubation
Insertion of the tracheal tube requires more >3 attempts or > 10
min, by 2 experienced operators, 2 type of blade
patient in an optimal position
optimal external laryngeal manipulation
Difficult Intubation
Stylet
Practice
Guidelines for
Management of
the Difficult
Airway. ASA Task
for on Difficult
Airway
Management.
Amended 2002
Videolaryngoscope
Glidescope
C-trach
C-MAC
Pentax-AWS
Airtraq
Disadvantages:
no airway protection
may need to release cricoid pressure to position LMA
Videolaryngoscope Devices
1.
2.
3.
4.
5.
Glidescope
Airtraq
C-trach
C-Mac
Pentax
Another Videolaryngoscope:
GlideScope
Application of Videolaryngoscope in
Difficult Airway
Routine elective intubation:
Decrease trauma
Improve laryngeal view
Supervision and documentation of laryngoscopy
Assessment of the oropharynx and quality of cricoid
pressure applied
Assists laryngeal manipulation to improve coordination for
tracheal intubation
Decrease haemodynamic changes
Application of Videolaryngoscope in
Difficult Airway
Anticipated difficult airway:
Awake videolaryngoscopy
Potentially easier learning curve then FOB
No restriction to the type and size of ETT that can be placed
Wider field of view than fibreoptic scope
Anti-fogging mechanism & less affected by secretions
Less expensive more durable than fibreoptic scope
Summary
Difficult airway continues to contribute to morbidity and
mortality, even in developed countries
Difficult airway management algorithm & failed intubation
drills are essential to prevent adverse outcomes
Supraglottic airway devices can be used as an airway
rescue device in unanticipated difficult airway
Summary:
Difficult Airway Algorithm
Anticipated:
Regional anaesthesia
Awake fibreoptic intubation/ Videolaryngoscope intubation
Unanticipated:
Can ventilate:
Wake patient, perform RA or awake intubation
Supraglottic airway (Proseal LMA) confirm placement & proceed with
surgery
Cant ventilate:
Supraglottic airway (Proseal LMA)
Cricothyroidotomy or surgical airway
Pelican Nebula
Thank You