Airway Assessment.pptx

Airway Assessment Health Assessment Key Points • An airway exam is performed on every patient for every encounter • Anesthesia is the airway expert • The airway exam is not 100% predictable of a difficult airway • Always obtain old records if there is a question about the airway • Know and be able...

Airway Assessment Health Assessment Key Points • An airway exam is performed on every patient for every encounter • Anesthesia is the airway expert • The airway exam is not 100% predictable of a difficult airway • Always obtain old records if there is a question about the airway • Know and be able to recite the Difficult Airway Algorithm - it will save a life • Arguably single most important aspect of assessment Airway Events • Adverse respiratory events constitute the single largest source of injury in the Closed Claims Project • Respiratory events are 64% of all claims in the 2000s • Three mechanisms: • Inadequate ventilation (25%) • Difficult intubation (22%) • Esophageal intubation (6%) Outcome, Payment, Frequency Components of Airway Exam • Length of upper incisors • Condition of teeth • Occlusion and mouth opening • Mandibular advance (mandibular prognathism) • Interincisor or inter gum distance • Visibility of uvula • Facial hair • Thyromental distance (TMD)/submental space • Length of neck • Neck circumference • ROM of head and neck Documentation Requirements • Mallampati score • Status of teeth • Degree of neck mobility • Neck circumference • TMD • Body habitus • Pertinent deformities Airway Exam Predictability • No single exam/test is 100% predictive of a difficult airway • The airway exam helps with anesthesia planning • Most predictive factor = history of difficult intubation • BUT, a previous ‘easy airway’ does not rule out potential difficulty Ventilation V. Intubation • Ventilation will save a life • Intubation is not required to ventilate • Ventilation will save a life • Intubation/laryngoscopy will mess up an airway • Ventilation will save a life • Intubation is not required to ventilate • Ventilation will save a life Predictors of Difficult Ventilation BVM Any Ventilation Method • Age > 55 years • BMI > 26 • Lack of teeth • Beard • Snoring history • OSA • Male • OSA • Snoring history • Obesity • Neck cir. > 17 inches • Head/neck radiation • Trauma • RA • Downs Syndrome • C-Spine injury/deformity Difficulty in BVM Ventilation • BOOTS • B – beard • O – obese • O – older • T – toothless • S – snoring Full Beard Predictors of Difficult Intubation • Facial deformities • Decreased neck ROM • Neck circumference >17 inches • Interincisor distance <3 cm (2 fingerbreadths) • Increasing Mallampati score • History of difficult intubation • < 3 fingerbreadth TMD (submental space) Mallampati Mallampati Classes • Class I: soft palate, fauces, entire uvula, tonsilar pillars • Class II: soft palate, facuces, portion of uvula • Class III: soft palate, base of uvula • Clakk IV: hard palate only Mallampati Classification • As a stand alone test, MP is insufficient for accurate prediction of difficult intubation • Performed without phonation • Has utility combined with other assessments • • • • • Neck ROM Mouth opening TMD Neck circumference Incisor length/shape • Never rely on just MP classification in your airway assessment Additional Tests • Upper Lip Bite Test (ULBT) • Predict difficult intubation with greater specificity and less variability that MP • Helps to determine degree of subluxation of the mandible • Wilson Score • Weight, head and neck movement, jaw movement, receding mandible, buck teeth ULBT ULBT TMD TMD TMD • Distance from the mentum to the thyroid notch with the neck fully extended • Help determine how readily the laryngeal axis lines up with the pharyngeal axis • If short, the larynx is reasonable anterior to the base of the tongue • Anything less than 6cm  laryngoscopy and intubation is impossible Airway Axis Tooth Numbering