Professional Documents
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Airway Management
Airway Management
MANAGEMENT
F. Heru Irwanto
Dept. Anestesi-Reanimasi
FK UNPAD-FK UNSRI
ANATOMY
Successful intubation, ventilation,
cricothyrotomy, and regional anesthesia of
the larynx require detailed knowledge of
airway anatomy.
There are two openings to the human airway:
- pars nasalis
- pars oralis
EQUIPMENT
STATICS
S : scope -> stethoscope, laryngoscope
T : tube
A : airway equipment
T : tape
I : introducer , stylet, mandrain
C: connector
S : suction
Rigid Laryngoscopes
A laryngoscope is an instrument used to
examine the larynx and to facilitate intubation
of the trachea.
The Macintosh and Miller blades are the
most popular curved and straight designs
The choice of blade depends on personal
preference and patient anatomy
A rigid laryngoscope
Tracheal Tubes
TTs can be used to deliver anesthetic gases
directly into the trachea and allow the most
control of ventilation and oxygenation
TTs are most commonly made from polyvinyl
chloride
The patient end of the tube is beveled to aid
visualization and insertion through the vocal
cords
Murphy tubes have a hole (the Murphy eye)
to decrease the risk of occlusion should the
distal tube opening abut the carina or trachea
Age
Internal
Diameter
(mm)
Cut Length
(cm)
Full-term infant
3.5
12
Female
6.5-7.0
24
Male
7.59.0
24
Child
Adult
TECHNIQUES OF DIRECT
LARYNGOSCOPY & INTUBATION
Intubation is not a risk-free procedure,
however, and not all patients receiving
general anesthesia require it
Successful intubation often depends on
correct patient positioning
Moderate head elevation (510 cm above
the surgical table) and extension of the
atlantooccipital joint place the patient in the
desired sniffing position
Orotracheal Intubation
The laryngoscope is held in the left hand
With the patient's mouth opened widely, the
blade is introduced into the right side of the
oropharynx
The tongue is swept to the left and up into the
floor of the pharynx by the blade's flange
The TT is taken with the right hand, and its tip
is passed through the abducted vocal cords
Difficult Airway
Other clues to a potentially difficult
laryngoscopy include :
limited neck extension (< 35)
a distance between the tip of the patient's mandible
and hyoid bone of less than 7 cm
a sternomental distance of less than 12.5 cm with
the head fully extended and the mouth closed
a poorly visualized uvula during voluntary tongue
protrusion (Mallampati classification)
Complications of Intubation
During laryngoscopy and intubation
Malpositioning
Esophageal intubation
Bronchial intubation
Airway trauma
Dental damage
- Lip, tongue, or mucosal laceration
- Sore throat
- Dislocated mandible
Physiological reflexes
Hypoxia, hypercarbia
Hypertension, tachycardia
Intracranial hypertension , Intraocular hypertension
Laryngospasm
Complications of Intubation
While the tube is in place
Malpositioning
Unintentional extubation, Bronchial intubation, Laryngeal
cuff position
Airway trauma
Mucosal inflammation and ulceration
Following extubation
Airway trauma
Edema and stenosis
Hoarseness (vocal cord granuloma or paralysis)
Laryngeal malfunction and aspiration
Laryngospasm