Airway Obstruction

 Occur in conscious, unconscious or during anesthesia

 Most common cause is tongue falling back into hypopharynx (in unconscious patient)
 Simple maneuvers to prevent that:
o Clearing airway from any foreign body
o Using chin lift maneuver
o Jaw thrust maneuver
o Artificial airway
 Oropharyngeal (Geudel airway)
 Nasopharyngeal
 Contraindicated in patients with severe trauma to head (many have
intrusion of brain tissue)
 If obstruction encountered, do not force it since severe bleeding may
occur
 Laryngeal mask
 Alternative to endotracheal intubation
 Advantage
o Not affected by shape of patient face or absence of teeth
o Does not require anesthetist to keep holding it in position
o Significantly reduce risk of aspiration (but does not eliminate it)
 Relative contraindication
o Regurgitation risk
o Emergency case
o Pregnancy and hiatus hernia patients
o Placing patient on their side semi-prone
 1-2-3 test (affect decision of endotracheal intubation)
o 1: TMJ mobility
 Must be able to insert 1 fingerbreadth in width between mandibular condyle
and tragus of ear
o 2: Mouth opening
 Ask patient open mouth maximally
 Should be able to insert at least 2 fingers between teeth
 Also Mallampti criteria
 Class I (pillars and all other)
 Class II (soft palate, fauces, portion of uvula)
 Class III (soft palate, base of uvula)
 Class IV (hard palate only)
o 3: Thyromental distance
 At least 3 fingerbreadth between mentum and thyroid notch
 Indication for endotracheal intubation
o Muscle relaxant use in surgery
o Full stomach/increased abdominal pressure patients
o Position of patient make airway maintenance difficult (prone)
 o Improving surgical access
o Cardiopulmonary resuscitation
o Competition between surgeon and anesthetist for airway
o To maintain airway satisfactorily
 Technique and steps
o Step 1: sniffing position (head extended and neck flexed)
o Step 2: open patient mouth
o Step 3: laryngoscopy
 Grading under direct laryngoscopy
 Grade 1 (full view of glottis)
 Grade 2 (only posterior part of glottis)
 Grade 3 (only epiglottis)
 Grade 4 (cannot see anything)
o Step 4: insert ETT through vocal cords and remove laryngoscope
 Confirmation of correct ETT placement
o Absolute proof
 Tube passing through vocal cords observed
 Measuring Co2 in expired gas (capnography)
 If 0.2% it indicate esophageal intubation
 Visualizing tracheal lumen using fiber optic scope
o Indirect
 Listening to apex of each lung
 Observe chest raising and falling with positive pressure ventilation
 Listening over epigastrium (absence of breath sounds with ventilation)