Airway Assessment
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Transcript of Airway Assessment
Airway Assessment, Airway Assessment, Difficult Airway Difficult Airway &Management&Management
Anatomy of LarynxAnatomy of Larynx
Basic anatomic componentsBasic anatomic components
Cartilaginous skeletonCartilaginous skeleton Intrinsic & extrinsic musclesIntrinsic & extrinsic muscles Mucosal liningMucosal lining
Anatomy of LarynxAnatomy of Larynx
Muscles of the larynxMuscles of the larynx
Tenses the vocal cordTenses the vocal cord CricothyroidCricothyroid vocalisvocalis
Opens &closes the glottisOpens &closes the glottis Abductor-post cricoarytenoidAbductor-post cricoarytenoid Adductor-lat cricoarytenoid, thyroarytenoidAdductor-lat cricoarytenoid, thyroarytenoid
arytenoidarytenoid
Muscles of the larynx—contdMuscles of the larynx—contd
Closes the vestibule of the larynxCloses the vestibule of the larynx
AryepiglottisAryepiglottis ThyroepiglotticusThyroepiglotticus thyroarytenoidthyroarytenoid
Nerve supply of the larynxNerve supply of the larynx
Motor supplyMotor supply Recurrent laryngeal nerveRecurrent laryngeal nerve External laryngeal nerveExternal laryngeal nerve
Sensory supplySensory supply Recurrent laryngeal nerveRecurrent laryngeal nerve Internal laryngeal nerveInternal laryngeal nerve
IntroductionIntroduction
““Airway” refers to the upper airway consisting Airway” refers to the upper airway consisting of the of the
-nasal cavity-nasal cavity
-oral cavity-oral cavity
-pharynx-pharynx
-larynx-larynx
-trachea-trachea
-principal bronchi -principal bronchi
Adult &Pediatric Airway DifferenceAdult &Pediatric Airway Difference
Smaller infant larynxSmaller infant larynx Narrowest portion-cricoid cartilage, vocal Narrowest portion-cricoid cartilage, vocal
foldsfolds Location-C3-C5 child,C4-6 adultLocation-C3-C5 child,C4-6 adult Epiglottis-longer ,narrower ,stifferEpiglottis-longer ,narrower ,stiffer Aryepiglottic fold-closer to midline in infantAryepiglottic fold-closer to midline in infant Mucosa-fragileMucosa-fragile
Assessment of airwayAssessment of airway
HistoryHistory
ExaminationExamination
nares- patency ,septumnares- patency ,septum
teeth-prominent incisors, edentulousteeth-prominent incisors, edentulous
palate-high arched, long narrowpalate-high arched, long narrow
neck-short, thick,massesneck-short, thick,masses
Airway AssessmentAirway Assessment
Specific testsSpecific tests 1.Inter-incisor distance- it is the distance1.Inter-incisor distance- it is the distance between the upper and lower incisorsbetween the upper and lower incisors >4 cm(2 finger breadth)>4 cm(2 finger breadth)
2.Atlanto -occipital joint extension-assess 2.Atlanto -occipital joint extension-assess feasibility for sniffing positionfeasibility for sniffing position
2.A-O Extension-aligns oral, pharyngeal,2.A-O Extension-aligns oral, pharyngeal,
laryngeal axis in a straight linelaryngeal axis in a straight line
N angle of extension-35 degreeN angle of extension-35 degree
3.Mallampatti test-correlates tongue size3.Mallampatti test-correlates tongue size
to pharyngeal sizeto pharyngeal size
Class I-IVClass I-IV
Mallampati ClassificationMallampati Classification
Class I-soft palate, fauces, uvula,tonsillarClass I-soft palate, fauces, uvula,tonsillar
pillars visiblepillars visible
Class II-soft palate, fauces, uvula visibleClass II-soft palate, fauces, uvula visible
Class III-soft palate, base of uvula visibleClass III-soft palate, base of uvula visible
Class IV-soft palate not visible Class IV-soft palate not visible
4.Mandibular Space4.Mandibular Space
i) Thyromental distance(Patil’s test) i) Thyromental distance(Patil’s test)
distance from mentum –thyroid notchdistance from mentum –thyroid notch
Normal>6 cmNormal>6 cm
ii)Sternomental distanceii)Sternomental distance
distance from mentum-suprasternal notchdistance from mentum-suprasternal notch
Normal>12 cmNormal>12 cm
iii)Mandibulohyoid distanceiii)Mandibulohyoid distance
distance from mentum-hyoiddistance from mentum-hyoid
Normal 4 cm(3 finger breath)Normal 4 cm(3 finger breath)
5.Mandibular translation5.Mandibular translation
ability to prognathability to prognath
Class A,B,CClass A,B,C
Wilson’s Scoring SystemWilson’s Scoring System
5 variables5 variables
head movementshead movements
neck& jaw movementsneck& jaw movements
weightweight
mandibular recessionmandibular recession
buck teethbuck teeth
LEMON AssessmentLEMON Assessment
L-look externally (trauma, beard, moustache)L-look externally (trauma, beard, moustache)
E-evaluate 3-3-2 ruleE-evaluate 3-3-2 rule
M-mallampati scoreM-mallampati score
O-obstruction (abscess, epiglottitis, trauma)O-obstruction (abscess, epiglottitis, trauma)
N-neck mobilityN-neck mobility
Benumof’s criteria for airway Benumof’s criteria for airway assessmentassessment
Interincisor distanceInterincisor distance Range of cervical motionRange of cervical motion Mandibular spaceMandibular space
Thyromental distanceThyromental distance Hyomental distanceHyomental distance
Mandibular translationMandibular translation
Contd…benumof’s criteriaContd…benumof’s criteria
Mallampati classificationMallampati classification Configuration of the palateConfiguration of the palate Thickness of the neckThickness of the neck Buck teethBuck teeth
Direct laryngoscopyDirect laryngoscopy Cormack& Lehane-Grade I-IVCormack& Lehane-Grade I-IV
Grade I-entire laryngeal aperture visibleGrade I-entire laryngeal aperture visible
Grade II-post commissure visibleGrade II-post commissure visible
Grade III-epiglottis visibleGrade III-epiglottis visible
Grade IV-soft palate visibleGrade IV-soft palate visible
Difficult AirwayDifficult Airway
ASA has defined it as a situation in which theASA has defined it as a situation in which the
“ “conventionally trained anesthetist hasconventionally trained anesthetist has
difficulty with mask ventilation or difficulty difficulty with mask ventilation or difficulty
with tracheal intubation or BOTH.” with tracheal intubation or BOTH.”
Difficult ventilationDifficult ventilation
inability of 1 anesthetist to maintain oxygeninability of 1 anesthetist to maintain oxygen
saturation >92%saturation >92%
significant gas leak around face masksignificant gas leak around face mask
use of FGF button >2use of FGF button >2
no chest movementno chest movement
2 handed mask ventilation needed2 handed mask ventilation needed
change of operator requiredchange of operator required
Difficult IntubationDifficult Intubation
unable to place an ETT with conventionalunable to place an ETT with conventional
laryngoscopy with >3 attemptslaryngoscopy with >3 attempts
takes >10 mins for intubation takes >10 mins for intubation
Difficult Airway-FactorsDifficult Airway-Factors
CongenitalCongenital
Pierre Robin Syndrome, Down’s SyndromePierre Robin Syndrome, Down’s Syndrome
Klippel Fiel syndromeKlippel Fiel syndrome AcquiredAcquired
Infections-croup, abscess, supraglottitisInfections-croup, abscess, supraglottitis
Arthritis-RA,ASArthritis-RA,AS
Tumors-lipoma, cystic hygroma, goitreTumors-lipoma, cystic hygroma, goitre
TraumaTrauma
ObesityObesity
BurnsBurns
THANK YOUTHANK YOU