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AUBUCHON - Airway Examination and Endotracheal Intubation- 100218
13
Airway Examination and
CREDITS
Endotracheal Intubation
Jessica Hatch
Andrew Yee
Jake AubuchON, MD
Department of Anesthesiology
REFERENCES
Washington University School of Medicine
https://www.clinicaladvisor.com
https://aneskey.com/
https://www.clarkmedicalmedia.com/
https://openanesthesia.org
Airway Examination and Endotracheal Intubation
COMPLICATIONS
RISK FACTORS
INDICATIONS
Patient Positioning
AIRWAY ANATOMY
EXAMINATION
DIRECT LARYNGOSCOPY
OF TRACHEAL INTUBATION
OF DIFFICULT AIRWAY
FOR INTUBATION
CERVICAL SPINE
INTER-INCISOR GAP
MALLAMPATI CLASSIFICATION
STEP
Infant in "Sniffing Position"
INCORRECT
INNERVATION
Induction and Laryngoscopy
AIRWAY
LARYNX
#2
EASY LAYNGOSCOPY
VERY DIFFICULT
DIFFICULT
#1
PLACEMENT
INTUBATION
EASY INTUBATION
INTUBATION
ST. LOUIS ZOO
TABLE POSITION AND HEIGHT
General Anesthesia
Congential
Less than 3 cm
may be difficult
- Pierre Robin
- Treacher Collins
- Goldenhar
- Down's
- Klippel-Feil
- Dental and oral trauma
- Hypertension, tachycardia, dysrhythmias
- Aspiration
- Larynogospasm
LARYNGOGOSCOPIC VIEWS
Class III
Class I
Class II
Class IV
Visualization with partial tonsilar fauces and pillars
Visualization with only base of uvula
Visualization of soft palate, tonsilar fauces and pillars, and uvula
Arch of soft palate is not visable
Infectious
Cormack-Lehane Classification
Atlanto-occipital joint
- Airway for general anesthesia
- Prevent aspiration
- Non-supine position
- Surgery near airway
- Inadequate mask ventilation
Xiphoid process
SUPERIOR LARYNGEAL
External Laryngeal Nerve Injury
>35 degree extension from sitting position is normal
Sensory function above vocal cords
Supraglottic edema, croup, epiglottis
Unopposed abduction
Changes to voice, not dangerous
Motor to cricothyroid muscle (adduction)
Intraoperative
MANDIBULAR PROTRUSION TEST
ANTERIOR MANDIBULAR SPACE
Vallecula
GRADE I
GRADE IV
GRADE II
GRADE III
Arthritic
Thyromental Distance
Partial visualization of cords
Full visualization of cords
Only epiglottis visible
Only soft palate visible
3 Finger Breadth
GRADE IIB
GRADE IIA
Rheumatoid arthritis, ankylosing spondylitis
RECURRENT LARYNGEAL
4-6 cm
Thyroid membrane
Need for frequent suctioning
Recurrent Laryngeal Nerve Injury
Motor to all other muscles
Sensory to vocal cords and trachea
Only arytenoids visible
Thyroid cartilage
Normal, easy intubation
4-6 cm
Unopposed cricothyroid closes cords
Unilateral - hoarse
Bilateral - complete obstruction
<4-6 cm
Need for positive pressure ventilation
Increasing difficulty
Masses
- ETT obstruction
- Endobronchial intubation
- Esophageal intubation
- Cuff leak
- Barotrauma
- Tracheal muscosa ischemia
- Accidental disconnect or extubation
Failure of spontaneous ventilation
Difficulty increases
Airway Burns
Unable to protect airway
Miller Blade
Macintosh Blade