BASIC AIRWAY MANAGEMENTBASIC AIRWAY MANAGEMENT

AirwayAirway Maintenance of a patent airway is an Maintenance of a patent airway is an

essential prerequisite for the safe essential prerequisite for the safe and successful conduct of and successful conduct of anaesthesia. However, it is a skill anaesthesia. However, it is a skill that should be acquired by all that should be acquired by all doctors, as during resuscitation doctors, as during resuscitation patients often have an obstructed patients often have an obstructed airway either as the airway either as the cause or result cause or result of their loss of consciousness of their loss of consciousness

Airway anatomyAirway anatomy

The term airway refers to the upper airway The term airway refers to the upper airway consisting of the nasal and oral cavities, consisting of the nasal and oral cavities, pharynx, larynx, trachea, and principal pharynx, larynx, trachea, and principal bronchi.bronchi.

The laryngeal skeleton consists of nine The laryngeal skeleton consists of nine cartilages that together house the vocal fold cartilages that together house the vocal fold (larynx situated C3-C6) (larynx situated C3-C6)

Trachea in adults measures about 15 Cm Trachea in adults measures about 15 Cm starts from the C6 and end at T5 (carina) starts from the C6 and end at T5 (carina) where it bifurcates into the right and left where it bifurcates into the right and left bronchi.bronchi.

Upper Airway AnatomyUpper Airway Anatomy

Upper Airway AnatomyUpper Airway Anatomy

Upper Airway AnatomyUpper Airway Anatomy

. The right main stem bronchus is . The right main stem bronchus is larger than the left and deviates from larger than the left and deviates from the plane of the trachea at a less the plane of the trachea at a less acute angle (aspirated material as acute angle (aspirated material as well as a deeply placed tracheal tube well as a deeply placed tracheal tube is more likely to enter the right than is more likely to enter the right than the left bronchus).the left bronchus).

Airway obstructionAirway obstruction

The majority of preventable deaths The majority of preventable deaths following trauma occur as a result of following trauma occur as a result of airway obstruction. airway obstruction.

Obstruction may occur at any point Obstruction may occur at any point within the airway, from the upper within the airway, from the upper airways to the bronchi deep within airways to the bronchi deep within the chest.the chest.

Common causes of airway obstructionCommon causes of airway obstruction

Upper Airway Upper Airway tongue (due to unconsciousness) tongue (due to unconsciousness) soft tissue swelling soft tissue swelling blood, vomit blood, vomit direct injury direct injury

Larynx (voice box) Larynx (voice box) foreign material, direct injury, soft foreign material, direct injury, soft

tissue swelling tissue swelling

Lower Airway Lower Airway secretions, edema, blood secretions, edema, blood bronchospasm bronchospasm aspiration of gastric contentsaspiration of gastric contents

Manual airway maneuvers, Manual airway maneuvers, head tilt and jaw thrusthead tilt and jaw thrust׃׃

IndicationsIndications -Initial management of a compromised airway.-Initial management of a compromised airway. -Stimulus to respiratory drive in the sedated -Stimulus to respiratory drive in the sedated

patient.patient. -Relief of mild anatomic airway obstruction.-Relief of mild anatomic airway obstruction. ..Head tilt contraindicated in suspected Head tilt contraindicated in suspected

cervical spine pathology e.g. rheumatoid cervical spine pathology e.g. rheumatoid arthritis so in these condition better to use arthritis so in these condition better to use jaw thrust only.jaw thrust only.

Oropharyngeal airwayOropharyngeal airway

An oropharyngeal airway (also known as an oral An oropharyngeal airway (also known as an oral airway, OPA or Guedel pattern airway) is a medical airway, OPA or Guedel pattern airway) is a medical device called an airway adjunct used to maintain a device called an airway adjunct used to maintain a patent (open) airway. It does this by preventing the patent (open) airway. It does this by preventing the tongue tongue from (either partially or completely) covering from (either partially or completely) covering the epiglottis, which could prevent the patient from the epiglottis, which could prevent the patient from breathing. When a person becomes unconscious or breathing. When a person becomes unconscious or anesthetized, the muscles in their jaw relax and may anesthetized, the muscles in their jaw relax and may allow the tongue to obstruct the airway; in fact, the allow the tongue to obstruct the airway; in fact, the tongue is the most common cause of a blocked airwaytongue is the most common cause of a blocked airway

The correct size OPA is chosen by measuring against The correct size OPA is chosen by measuring against the patient's head (from the earlobe to the corner of the patient's head (from the earlobe to the corner of the mouth).the mouth).

The preferred technique is to use a tongue blade to The preferred technique is to use a tongue blade to depress the tongue and then insert the airway depress the tongue and then insert the airway posteriorly. posteriorly.

An alternate technique is to insert the oral airway An alternate technique is to insert the oral airway upside down until the soft palate is reached, rotate upside down until the soft palate is reached, rotate the device 180 degrees and slip it over the tongue, the device 180 degrees and slip it over the tongue, its fully inserted until the flange lies in front of the its fully inserted until the flange lies in front of the teeth, or gums in an edentulous patient.teeth, or gums in an edentulous patient.

Be sure not to use the airway to push the tongue Be sure not to use the airway to push the tongue backward and block, rather than clear the airway.backward and block, rather than clear the airway.

To remove the device, it is pulled out following the To remove the device, it is pulled out following the curvature of the tongue; no rotation is necessary curvature of the tongue; no rotation is necessary

This device is poorly tolerated in conscious This device is poorly tolerated in conscious patients and may induce gagging, vomiting and patients and may induce gagging, vomiting and aspiration.aspiration.

Oropharyngeal airway Oropharyngeal airway insertioninsertion

Nasopharyngeal airwayNasopharyngeal airway

Round, malleable plastic tubes, beveled at Round, malleable plastic tubes, beveled at the pharyngeal end and flanged at the nasal the pharyngeal end and flanged at the nasal endend

It inserted through a nostril and creates an It inserted through a nostril and creates an air passage between the nose and the air passage between the nose and the nasopharynx. nasopharynx.

Any tube inserted through the nose should be Any tube inserted through the nose should be well lubricated and use a nostril that’s well lubricated and use a nostril that’s unobstructedunobstructed

The airway is inserted along the floor of the nose, The airway is inserted along the floor of the nose, with the bevel facing medially to avoid catching the with the bevel facing medially to avoid catching the turbinatesturbinates

The nasopharyngeal airway is preferred to the The nasopharyngeal airway is preferred to the oropharyngeal airway in conscious patients because oropharyngeal airway in conscious patients because it’s better tolerated and less likely to induce a gag it’s better tolerated and less likely to induce a gag reflex.reflex.

Nasopharyngeal airways are sometimes used by Nasopharyngeal airways are sometimes used by people who have sleep apnea. in a patient having people who have sleep apnea. in a patient having epileptic seizures whose teeth are clenched shut, epileptic seizures whose teeth are clenched shut, suction of the upper airways may also be applied via suction of the upper airways may also be applied via an NPAan NPA

Nasopharyngeal airway contraindicated in patients Nasopharyngeal airway contraindicated in patients with severe head or facial injuries, or has evidence of with severe head or facial injuries, or has evidence of a basal skull fracture due to the possibility of direct a basal skull fracture due to the possibility of direct intrusion upon brain tissue, those who are intrusion upon brain tissue, those who are anticoagulated, patients with nasal infections as well anticoagulated, patients with nasal infections as well as in children (because of risk of epistaxis) as in children (because of risk of epistaxis)