Practical Anesthesia, Stage Two, Course 1 Lecture 2, Artificial Airway, 2024-2025, Al Mustaqbal University PDF

Al Mustaqbal University College of Health and Medical Techniques Department of Anesthesia Practical Anesthesia Stage Two Course 1 Lecture 2 Artificial Airway By Lectures Nofal Aja...

Al Mustaqbal University College of Health and Medical Techniques Department of Anesthesia Practical Anesthesia Stage Two Course 1 Lecture 2 Artificial Airway By Lectures Nofal Ajami, Mohammed Saadi, Mohammed Ali BSc. Anesthesia & Intensive Care 2024 – 2025 1  Artificial airway ‫ﻣﺟرى اﻟﮭواء اﻻﺻطﻧﺎﻋﻲ‬ Artificial airway: Airways are devices that can be passed orally or through the nose to maintain the patency of air passages. ‫ اﻟﺧطوط اﻟﺟوﯾﺔ ھﻲ أﺟﮭزة ﯾﻣﻛن ﺗﻣرﯾرھﺎ ﻋن طرﯾﻖ اﻟﻔم أو ﻣن ﺧﻼل اﻷﻧف ﻟﻠﺣﻔﺎظ ﻋﻠﻰ ﺳﺎﻟﻛﯾﺔ‬:‫ﻣﺟرى اﻟﮭواء اﻻﺻطﻧﺎﻋﻲ‬.‫اﻟﻣﻣرات اﻟﮭواﺋﯾﺔ‬ Note: Unlike other maneuvers to maintain a patent airway, including chin lift, jaw thrust and tracheal intubation, insertion of an airway does not affect the stability of the cervical spine. ‫ ﻓﺈن‬،‫ ﺑﻣﺎ ﻓﻲ ذﻟك رﻓﻊ اﻟذﻗن ودﻓﻊ اﻟﻔك واﻟﺗﻧﺑﯾب اﻟرﻏﺎﻣﻲ‬،‫ ﻋﻠﻰ ﻋﻛس اﻟﻣﻧﺎورات اﻷﺧرى ﻟﻠﺣﻔﺎظ ﻋﻠﻰ ﻣﺟرى اﻟﮭواء‬:‫ﻣﻼﺣظﺔ‬.‫إدﺧﺎل ﻣﺟرى اﻟﮭواء ﻻ ﯾؤﺛر ﻋﻠﻰ اﺳﺗﻘرار اﻟﻌﻣود اﻟﻔﻘري اﻟﻌﻧﻘﻲ‬ Oropharyngeal Airway: ‫ﻣﺟرى اﻟﮭواء اﻟﻔﻣوي اﻟﺑﻠﻌوﻣﻲ‬ This anatomically shaped airway is inserted through the mouth into the oropharynx above the tongue to maintain the patency of the upper airway in cases of upper airway obstruction caused by a decreased level of consciousness. ‫ﯾﺗم إدﺧﺎل ھذا ﻣﺟرى اﻟﮭواء ذو اﻟﺷﻛل اﻟﺗﺷرﯾﺣﻲ ﻣن ﺧﻼل اﻟﻔم إﻟﻰ اﻟﺑﻠﻌوم اﻟﻔﻣوي ﻓوق اﻟﻠﺳﺎن ﻟﻠﺣﻔﺎظ ﻋﻠﻰ ﺳﺎﻟﻛﯾﺔ ﻣﺟرى‬.‫اﻟﮭواء اﻟﻌﻠوي ﻓﻲ ﺣﺎﻻت اﻧﺳداد ﻣﺟرى اﻟﮭواء اﻟﻌﻠوي اﻟﻧﺎﺟم ﻋن اﻧﺧﻔﺎض ﻣﺳﺗوى اﻟوﻋﻲ‬ 2 Note: Decreased consciousness can lead to loss of pharyngeal tone that can result in airway obstruction by the tongue, epiglottis, soft palate or pharyngeal tissues. Note: The most common type is the Guedel airway. ‫ ﯾﻣﻛن أن ﯾؤدي اﻧﺧﻔﺎض اﻟوﻋﻲ إﻟﻰ ﻓﻘدان ﻧﻐﻣﺔ اﻟﺑﻠﻌوم ﻣﻣﺎ ﻗد ﯾؤدي إﻟﻰ اﻧﺳداد ﻣﺟرى اﻟﮭواء ﻋن طرﯾﻖ اﻟﻠﺳﺎن أو‬:‫ﻣﻠﺣوظﺔ‬.‫ﻟﺳﺎن اﻟﻣزﻣﺎر أو اﻟﺣﻧك اﻟرﺧو أو أﻧﺳﺟﺔ اﻟﺑﻠﻌوم‬.‫ﻋﺎ ھو ﻣﺟرى ﺟوﯾدل اﻟﮭواﺋﻲ‬ ً ‫ اﻟﻧوع اﻷﻛﺛر ﺷﯾو‬:‫ﻣﻠﺣوظﺔ‬ Uses: ‫اﻻﺳﺗﺧداﻣﺎت‬  It prevents obstruction of the upper air passage by lifting the tongue and epiglottis away from the posterior pharyngeal wall. ‫ ﯾﻣﻧﻊ اﻧﺳداد ﻣﺟرى اﻟﮭواء اﻟﻌﻠوي ﻋن طرﯾﻖ رﻓﻊ اﻟﻠﺳﺎن وﻟﺳﺎن‬.‫اﻟﻣزﻣﺎر ﺑﻌﯾدا ﻋن ﺟدار اﻟﺑﻠﻌوم اﻟﺧﻠﻔﻲ‬  It prevents biting and occlusion of the ET tube..ET ‫ ﯾﻣﻧﻊ ﻋض واﻧﺳداد اﻷﻧﺑوب‬  It protects the tongue during biting and seizure activity..‫ ﯾﺣﻣﻲ اﻟﻠﺳﺎن أﺛﻧﺎء ﻧﺷﺎط اﻟﻌض واﻟﻧوﺑﺎت‬  It facilitates oropharyngeal suctioning..‫ ﯾﺳﮭل ﻋﻣﻠﯾﺔ اﻟﺷﻔط ﻣن اﻟﻔم واﻟﺑﻠﻌوم‬ Problems of Oropharyngeal Airway: ‫ﻣﺷﺎﻛل ﻣﺟرى اﻟﮭواء اﻟﻔﻣوي اﻟﺑﻠﻌوﻣﻲ‬ 1. Trauma to the different tissues during insertion or trauma to the teeth. 2. If inserted in a patient whose pharyngeal reflexes are not depressed enough, the gag reflex can be induced that might lead to vomiting and laryngospasm. 3. They confer no protection against aspiration. 4. Too small an airway may cause kinking of the tongue and obstructing gas movement. 5. Too large an airway may cause obstruction by displacing the epiglottis and may traumatize the larynx..‫ ﺣدوث ﺻدﻣﺔ ﻟﻸﻧﺳﺟﺔ اﻟﻣﺧﺗﻠﻔﺔ أﺛﻧﺎء اﻹدﺧﺎل أو ﺣدوث ﺻدﻣﺔ ﻟﻸﺳﻧﺎن‬.1 ‫ ﻓﯾﻣﻛن ﺗﺣﻔﯾز ﻣﻧﻌﻛس اﻟﺑﻠﻌوم اﻟذي ﻗد ﯾؤدي‬،‫ إذا ﺗم إدﺧﺎﻟﮫ ﻓﻲ ﻣرﯾض ﻟم ﺗﻛن ردود أﻓﻌﺎﻟﮫ اﻟﺑﻠﻌوﻣﯾﺔ ﻣﻧﺧﻔﺿﺔ ﺑدرﺟﺔ ﻛﺎﻓﯾﺔ‬.2.‫إﻟﻰ اﻟﻘﻲء وﺗﺷﻧﺞ اﻟﺣﻧﺟرة‬.‫ أﻧﮭﺎ ﻻ ﺗوﻓر أي ﺣﻣﺎﯾﺔ ﺿد اﻟطﻣوح‬.3.‫ ﻗد ﯾؤدي ﺻﻐر ﻣﺟرى اﻟﮭواء إﻟﻰ ﺛﻧﻲ اﻟﻠﺳﺎن وإﻋﺎﻗﺔ ﺣرﻛﺔ اﻟﻐﺎزات‬.4.‫ ﻗد ﯾﺗﺳﺑب ﻛﺑر ﻣﺟرى اﻟﮭواء ﻓﻲ ﺣدوث اﻧﺳداد ﻋن طرﯾﻖ إزاﺣﺔ ﻟﺳﺎن اﻟﻣزﻣﺎر وﻗد ﯾؤدي إﻟﻰ إﺻﺎﺑﺔ اﻟﺣﻧﺟرة ﺑﺎﻟﺻدﻣﺔ‬.5 3  Correct size Too small Too large ‫اﻟﺣﺟم اﻟﺻﺣﯾﺢ‬ ‫ﺻﻐﯾر ﺟدًا‬ ‫ﻛﺑﯾر ﺟدًا‬ Insertion Technique: ‫ﺗﻘﻧﯾﺔ اﻹدراج‬ The patient’s mouth is opened and a well-lubricated airway is inserted into the oral cavity in the upside-down position as far as the junction between the head and the soft palate, then rotated through 180°. It is then inserted further until it lies in the oropharynx. This rotation technique minimizes the chance of pushing the tongue backward and downward. ‫ﯾﺗم ﻓﺗﺢ ﻓم اﻟﻣرﯾض وإدﺧﺎل ﻣﺟرى ھواﺋﻲ ﺟﯾد اﻟﺗﺷﺣﯾم ﻓﻲ ﺗﺟوﯾف اﻟﻔم ﻓﻲ وﺿﻊ ﻣﻘﻠوب ﺣﺗﻰ اﻟوﺻل ﺑﯾن اﻟرأس واﻟﺣﻧك‬ ‫ ﺗﻘﻠل ﺗﻘﻧﯾﺔ اﻟﺗدوﯾر ھذه ﻣن ﻓرﺻﺔ دﻓﻊ‬.‫ ﺛم ﯾﺗم إدﺧﺎﻟﮫ أﻛﺛر ﺣﺗﻰ ﯾﻘﻊ ﻓﻲ اﻟﺑﻠﻌوم اﻟﻔﻣوي‬.‫ درﺟﺔ‬180 ‫ ﺛم ﯾدور ﺑزاوﯾﺔ‬،‫اﻟرﺧو‬.‫اﻟﻠﺳﺎن ﻟﻠﺧﻠف وﻟﻸﺳﻔل‬ 4 Nasopharyngeal airway: ‫ﻣﺟرى اﻟﮭواء اﻷﻧﻔﻲ اﻟﺑﻠﻌوﻣﻲ‬ This airway is inserted through the nose into the nasopharynx, bypassing the mouth and the oropharynx. The distal end is just above the epiglottis and below the base of the tongue. ً ‫ ﺗﻘﻊ اﻟﻧﮭﺎﯾﺔ اﻟﺑﻌﯾدة ﻓوق ﻟﺳﺎن‬.‫ﻣﺗﺟﺎوزا اﻟﻔم واﻟﺑﻠﻌوم اﻟﻔﻣوي‬ ،‫ﯾﺗم إدﺧﺎل ھذا ﻣﺟرى اﻟﮭواء ﻣن ﺧﻼل اﻷﻧف إﻟﻰ اﻟﺑﻠﻌوم اﻷﻧﻔﻲ‬.‫اﻟﻣزﻣﺎر ﻣﺑﺎﺷرة وﺗﺣت ﻗﺎﻋدة اﻟﻠﺳﺎن‬ Uses: ‫اﻻﺳﺗﺧداﻣﺎت‬ 1. It is an alternative to the oropharyngeal airway when the mouth cannot be opened or an oral airway does not relieve the obstruction. 2. Nasotracheal suction can be performed using a catheter passed through the nasal airway. 3. It is better tolerated by semi-awake patients than the oral airway. 4. The size inserted can be estimated as size 6 for an average-height female and size 7 for an average-height male..‫ إﻧﮫ ﺑدﯾل ﻟﻣﺟرى اﻟﮭواء اﻟﻔﻣوي اﻟﺑﻠﻌوﻣﻲ ﻋﻧدﻣﺎ ﻻ ﯾﻣﻛن ﻓﺗﺢ اﻟﻔم أو ﻋﻧدﻣﺎ ﻻ ﯾﺧﻔف ﻣﺟرى اﻟﮭواء اﻟﻔﻣوي اﻻﻧﺳداد‬.1.‫ ﯾﻣﻛن إﺟراء اﻟﺷﻔط اﻷﻧﻔﻲ اﻟرﻏﺎﻣﻲ ﺑﺎﺳﺗﺧدام ﻗﺳطرة ﯾﺗم ﺗﻣرﯾرھﺎ ﻋﺑر ﻣﺟرى اﻟﮭواء اﻷﻧﻔﻲ‬.2.‫ ﯾﺗﺣﻣﻠﮫ اﻟﻣرﺿﻰ ﺷﺑﮫ اﻟﻣﺳﺗﯾﻘظﯾن ﺑﺷﻛل أﻓﺿل ﻣن ﻣﺟرى اﻟﮭواء اﻟﻔﻣوي‬.3.‫ ﻟﻠذﻛور ﻣﺗوﺳطﻲ اﻻرﺗﻔﺎع‬7 ‫ ﻟﻺﻧﺎث ﻣﺗوﺳطﺔ اﻟطول واﻟﻣﻘﺎس‬6 ‫ ﯾﻣﻛن ﺗﻘدﯾر اﻟﺣﺟم اﻟﻣدرج ﺑﺎﻟﻣﻘﺎس‬.4 Insertion technique: ‫ﺗﻘﻧﯾﺔ اﻹدراج‬ 1. A lubricant is used to help in its insertion. 2. Once lubricated, it can be inserted through either nares, although the left-facing bevel is designed to ease insertion into the right nostril. On insertion, it should be passed backward through the nasopharynx, such that its distal end lies beyond the pharyngeal border of the soft palate but not beyond the epiglottis..‫ ﯾﺗم اﺳﺗﺧدام ﻣﺎدة ﺗﺷﺣﯾم ﻟﻠﻣﺳﺎﻋدة ﻓﻲ إدﺧﺎﻟﮭﺎ‬.1 ‫ ﻋﻠﻰ اﻟرﻏم ﻣن أن اﻟﻣﺷطوف اﻟﻣواﺟﮫ ﻟﻠﯾﺳﺎر ﻣﺻﻣم ﻟﺗﺳﮭﯾل‬،‫ ﯾﻣﻛن إدﺧﺎﻟﮫ ﻣن ﺧﻼل أي ﻣن ﻓﺗﺣﺗﻲ اﻷﻧف‬،‫ ﺑﻣﺟرد ﺗﺷﺣﯾﻣﮫ‬.2 ‫ ﺑﺣﯾث ﺗﻘﻊ ﻧﮭﺎﯾﺗﮫ اﻟﺑﻌﯾدة ﺧﻠف‬،‫ ﯾﺟب أن ﯾﺗم ﺗﻣرﯾره ﻟﻠﺧﻠف ﻋﺑر اﻟﺑﻠﻌوم اﻷﻧﻔﻲ‬،‫ ﻋﻧد اﻹدﺧﺎل‬.‫اﻹدﺧﺎل ﻓﻲ ﻓﺗﺣﺔ اﻷﻧف اﻟﯾﻣﻧﻰ‬.‫اﻟﺣدود اﻟﺑﻠﻌوﻣﯾﺔ ﻟﻠﺣﻧك اﻟرﺧو وﻟﻛن ﻟﯾس ﺧﻠف ﻟﺳﺎن اﻟﻣزﻣﺎر‬ 5  Problems of Nasopharyngeal airway: ‫ﻣﺷﺎﻛل ﻣﺟرى اﻟﮭواء اﻷﻧﻔﻲ اﻟﺑﻠﻌوﻣﻲ‬ 1. Airway obstruction: If larger sized airway is used, it may act as an foreign body in the airway. 2. Epistaxis: Trauma to septal mucosa, nasal polyps or adenoidal tissue can cause epistaxis. 3. Trauma: to the tongue, nose, uvula, pharynx and teeth. 4. Long oropharyngeal or nasopharyngeal airway can cause laryngospasm. 5. Latex allergy. 6. Tissue edema. 7. Ulceration and necrosis. 8. Central nervous system (CNS) trauma in a patient with basilar skull fracture. 9. Retention, aspiration, or swallowing..‫ ﻓﻘد ﯾﻌﻣل ﻛﺟﺳم ﻏرﯾب ﻓﻲ ﻣﺟرى اﻟﮭواء‬،‫ إذا ﺗم اﺳﺗﺧدام ﻣﺟرى ھواﺋﻲ أﻛﺑر ﺣﺟ ًﻣﺎ‬:‫ اﻧﺳداد ﻣﺟرى اﻟﮭواء‬.1.‫ اﻟﺻدﻣﺔ اﻟﺗﻲ ﺗﺻﯾب اﻟﻐﺷﺎء اﻟﻣﺧﺎطﻲ ﻟﻠﺣﺎﺟز أو اﻟزواﺋد اﻟﻠﺣﻣﯾﺔ اﻷﻧﻔﯾﺔ أو اﻷﻧﺳﺟﺔ اﻟﻐداﻧﯾﺔ ﯾﻣﻛن أن ﺗﺳﺑب اﻟرﻋﺎف‬:‫ اﻟرﻋﺎف‬.2.‫ ﻓﻲ اﻟﻠﺳﺎن واﻷﻧف واﻟﻠﮭﺎة واﻟﺑﻠﻌوم واﻷﺳﻧﺎن‬:‫ اﻟﺻدﻣﺎت‬.3.‫ ﻣﺟرى اﻟﮭواء اﻟﻔﻣوي اﻟﺑﻠﻌوﻣﻲ أو اﻟﺑﻠﻌوﻣﻲ اﻟطوﯾل ﯾﻣﻛن أن ﯾﺳﺑب ﺗﺷﻧﺞ اﻟﺣﻧﺟرة‬.4.‫ ﺣﺳﺎﺳﯾﺔ اﻟﻼﺗﻛس‬.5.‫ وذﻣﺔ اﻷﻧﺳﺟﺔ‬.6.‫ اﻟﺗﻘرح واﻟﻧﺧر‬.7.‫ ﺻدﻣﺔ اﻟﺟﮭﺎز اﻟﻌﺻﺑﻲ اﻟﻣرﻛزي ﻟدى ﻣرﯾض ﻣﺻﺎب ﺑﻛﺳر ﻗﺎﻋدي ﻓﻲ اﻟﺟﻣﺟﻣﺔ‬.8.‫اﻻﺣﺗﺑﺎس أو اﻟﺷﻔط أو اﻟﺑﻠﻊ‬.9 6 Important note: ‫ﻣﻼﺣظﺔ ھﺎﻣﺔ‬ 1. Nasopharyngeal airway use is not recommended when the patient has a bleeding disorder, is on anticoagulants, or has nasal deformities or sepsis. 2. Excess force should not be used during insertion as a false passage may be created. There is a potential risk of intracranial placement in cases of basal skull fracture. 3. An airway that is too large can result in pressure necrosis of the nasal and oral cavity, whereas an airway that is too small may be ineffective at relieving airway obstruction. 4. Pharyngeal and laryngeal reflexes should be depressed to prevent coughing and laryngospasm 5. Appropriate size must be used. 6. The airways must be inserted after lubrication. ،‫ أو ﯾﺗﻧﺎول ﻣﺿﺎدات اﻟﺗﺧﺛر‬،‫ ﻻ ﯾُﻧﺻﺢ ﺑﺎﺳﺗﺧدام ﻣﺟرى اﻟﮭواء اﻷﻧﻔﻲ اﻟﺑﻠﻌوﻣﻲ ﻋﻧدﻣﺎ ﯾﻌﺎﻧﻲ اﻟﻣرﯾض ﻣن اﺿطراب ﻧزﯾف‬.1.‫أو ﯾﻌﺎﻧﻲ ﻣن ﺗﺷوھﺎت ﻓﻲ اﻷﻧف أو ﺗﻌﻔن اﻟدم‬ ‫ ھﻧﺎك ﺧطر ﻣﺣﺗﻣل ﻟﻠوﺿﻊ داﺧل اﻟﺟﻣﺟﻣﺔ ﻓﻲ‬.‫ ﻻ ﯾﻧﺑﻐﻲ اﺳﺗﺧدام اﻟﻘوة اﻟزاﺋدة أﺛﻧﺎء اﻹدﺧﺎل ﻷﻧﮫ ﻗد ﯾﺗم إﻧﺷﺎء ﻣﻣر زاﺋف‬.2.‫ﺣﺎﻻت ﻛﺳر اﻟﺟﻣﺟﻣﺔ اﻟﻘﺎﻋدﯾﺔ‬ ‫ ﻓﻲ ﺣﯾن أن ﻣﺟرى اﻟﮭواء اﻟﺻﻐﯾر ﺟدًا‬،‫ ﯾﻣﻛن أن ﯾؤدي ﻣﺟرى اﻟﮭواء اﻟﻛﺑﯾر ﺟدًا إﻟﻰ ﻧﺧر اﻟﺿﻐط ﻓﻲ ﺗﺟوﯾف اﻷﻧف واﻟﻔم‬.3.‫ﻗد ﯾﻛون ﻏﯾر ﻓﻌﺎل ﻓﻲ ﺗﺧﻔﯾف اﻧﺳداد ﻣﺟرى اﻟﮭواء‬ ‫ ﯾﺟب ﺗﺛﺑﯾط اﻟﻣﻧﻌﻛﺳﺎت اﻟﺑﻠﻌوﻣﯾﺔ واﻟﺣﻧﺟرﯾﺔ ﻟﻣﻧﻊ اﻟﺳﻌﺎل وﺗﺷﻧﺞ اﻟﺣﻧﺟرة‬.4.‫ ﯾﺟب اﺳﺗﺧدام اﻟﺣﺟم اﻟﻣﻧﺎﺳب‬.5.‫ ﯾﺟب إدﺧﺎل ﻣﺟﺎري اﻟﮭواء ﺑﻌد اﻟﺗﺷﺣﯾم‬.6 7