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ASSESSMENT AND
MANAGEMENT
BY
DR AZHAR
DEFFINATION
American society of Anesthesiologist (ASA)
suggested that when sign of inadequate
ventilation could not be reversed by mask
ventilation or oxygen saturation could not be
maintained above 90% or
if a trained Anaesthetist usinig conventional
larangoscope takes more than 3 attempts or
more than 10 minute are required to complete
tracheal intubation
PREVALENCE
Fact of the matter is even with proper evaluation
only 15 to 50 % were picked up while
difficult face mask ventilation in general is
about 1:10,000 out of which again 15% proved
to be the difficult intubation ,while incidence
of extreme difficult or abandons intubation in
general surgery patients are 1:2000 but in
obstetrics is 1:300 and of course most critical
incidence is Hypoxia
2.
3.
4.
5.
6.
CAUSES OF
DIFFICULT INTUBATION
1.
2.
3.
4.
5.
6.
Anaesthetist
Inadequate preoperative assessment.
Inadequate equipments.
Experience not enough.
Poor technique.
Malfunctioning of equipment.
Inexperience assistanance
Patient
1.
2.
Congenital causes
Acquired causes
Short Neck.
Protruding incisor teeth.
Long high arched palate.
Poor mobility of neck.
Increase in either anterior depth or Posterior
depth of the mandible decrease in Atlanto
Occipital distance that's why role of
Radiology has increased in our specialty
ASSESSMENT OF AIRWAY
Mallampati classification with
larangoscopic view.
Patils Test
Measurement of
Atlanto-Occepital Angle
MANAGEMENT PLAN OF
ANTICEPATED DIFFICULT
AIRWAY
1.
2.
3.
4.
5.
6.
TECHNIQUE OF MANAGEMENT
1.
2.
3.
4.
5.
6.
7.
11
alternative
alternative
22
alternative
alternative
33
1
Manipulation of airway
different blade, bugie
2
LMA, ILMA, Combitube
3
Trantracheal Jet Ventilation
alternative
alternative
44
alternative
alternative
4
Cricothireotomy, Tracheostomy
GALLERY OF TOOLS
GALLERY OF TOOLS
Bullard laryngoscope
optic
Fiber
Mini Tracheostomy
BLIND NASAL,
RETROGRADE
AND HIGH FREQUENCY VENTILATION
Awake Intubation
ASA ALLOGORYTHAM
ASA ALLGORYTHAM
C-SPINE OA
THANK YOU
VERY MUCH
FOR YOUR
ATTENTION