Anaesthesia & Equipment - Airway Lecture (2) - PDF

ANAESTHESIA & ANAESTHESIA EQUIPMENT Air way Lecture (2) P O R T F O L I O ALNOOR UNIVERSITY COLLEGE College of Health and Medical Olivia Wilson Techniques DR. Radwan AL-Bakr i Abd ul Aziz Riyad h...

ANAESTHESIA & ANAESTHESIA EQUIPMENT Air way Lecture (2) P O R T F O L I O ALNOOR UNIVERSITY COLLEGE College of Health and Medical Olivia Wilson Techniques DR. Radwan AL-Bakr i Abd ul Aziz Riyad h Rania Name er 1 Airway management 2 Airway obstruction even if temporary is 3 dangerous and should be treated soon. 4 Usually obstruction is seen at the induction of 5 anesthesia or at the recovery from anesthesia ,but sometimes we face this problem any 6 were even at home , and to manage this 7 problem there are many steps : 8 9 10  Steps to management Airway obstruction 1 1.Extension of the head of the patient with pulling up of the lower jaw at the same time(closing the mouth ) 2 with flexion of the neck (sniff position) , this maneuver will open the pharynx so that the patient 3 can breathe from his nose freely. 4 2.Jaw thrust ,that is to put fingers on both side of the 5 lower jaw behind its angles and pushing the lower jaw 6 upward with opening the mouth, still the head is extended.this action will help in displacing the 7 tongue from the palate and the airway is free now 8 9 10 Both the above maneuvers should be followed by insertion of Oropharyngeal airway if the obstruction is not relived.  Oropharyngeal airway 1 Airway is an instrument which helps maintain the patency of the air passage for unobstructed 2 breathing. It is a curved apparatus made of metal, 3 plastic or hard rubber. It has a flange at the proximal (buccal) end which limits the depth of insertion. It 4 may also serve as a means to fix the airway in place. The flange may or may not rest on the patients lips 5 depending 6 uses 7 1. It prevents obstruction of the upper air passage by lifting the tongue and epiglottis away from the 8 posterior pharyngeal wall 9 2. It protects the tongue during biting and seizure 10 activity 3. It facilitates oropharyngeal suctioning 4. It provides a better mask fit for ventilation  INSERTION TECHNIQUE An estimate of the appropriate size is obtained by 1 selecting it with the length corresponding to the 2 vertical distance between the patient’s incisor and the 3 angle of the jaw. Too small an airway may cause kinking of the tongue and obstructing gas movement. 4 Too large an airway may cause obstruction by displacing the epiglottis and may traumatize the 5 larynx. The patient’s mouth is opened and a well- 6 lubricated airway is inserted into the oral cavity in Opposite side of tongue as far as the junction 7 between the head and the soft palate and then 8 rotated through 180°. It is then inserted further until it 9 lies in the oropharynx. This rotation technique minimizes the chance of pushing the tongue backward 10 and downward. 1 Complication: 2 1. Trauma to the different tissues during insertion. 2. Trauma to the teeth, crowns/caps if the patient bites on it. 3 3. aspiration (no protection against aspiration). 4 4. Inappropriately size ( airway obstruction if too small size) , ( laryngospasm if too big size). 5 6 7 Contraindications: 1. Avoid using an oropharyngeal airway on a conscious patient with an intact gag reflex. 8 2. If the patient has a foreign body obstructing the airway 9 10  Nasopharyngeal Airway It is an alternative that can be used to maintain the airway by inserting it through the 1 nose. It is useful in patients who have limited mouth opening or pathology of oral cavity that makes it difficult to insert oral airway.It is better tolerated in a semi-awake 2 patient than an oral airway and is less likely to be accidentally displaced or removed. 3 Nasopharyngeal airways are made of soft plastic, polyurethane or latex rubber and 4 have either a fixed or adjustable flange at its proximal end and a beveled distal end. It curves to fit the curvature of the nasopharynx. It is available in a range of lengths and 5 internal diameters. 6 7 USES 8 1. To facilitate suctioning and as a guide for nasogastric tube. 9 2. used in semi-awake or awake patient 3. as a guide for a fiberscope and to maintain ventilation during fiberoptic endoscopy. 10 4. To dilate the nasal passages in preparation for nasotracheal intubation. 5. Used in dental surgery.  Insertion Technique The length of the airway needed for the patient is 1 calculated as the distance from the tip of the nose to 2 the meatus of the ear. After lubricating it along its entire length, it is held in the hand on the same side as 3 it is to be inserted. It is inserted through the nares, 4 bevel end first. It is passed vertically along the floor of 5 the nose with slight twisting action and the curve of the airway should be directed toward the patient’s 6 feet. 7 8 9 10 1 2 Contraindications 3 1. Anticoagulation ( coagulopathy). 4 2. Basilar skull fracture. 5 3. Pathology(polyp), or deformity of the nose or nasopharynx. 4. Bleeding disorder or a history of nose bleeds requiring medical treatment. 6 7 8 9 10 1 2 3 4 5 6 7 8 9 10 1 2 Thank you 3 4 5 6 7 8 9 10