Anesthesia Clinical Rotation - Air Way Management

Anesthesia Clinical Rotation 2007 Female Group E1

.. I've made this note depending on my notes I wrote during the rotation .. Hope you find it helpful & useful .. Wish you all the best & don't forget me from your prayers Best of luck in the exam 

Iman A. Al-Mukhtar

..Air way Management : Air way Obstruction :  Signs of Air way Obstruction in non-intubated patients . Noisy Breathing The commonest sign -1 . Using the accessory respiratory muscles -2 . By Auscultation : unequal air entry to both lungs -3 .Air hunger & distress -4 . Cyanosis in sever or prolonged obstruction -5  Common Causes of Air way Obstruction in non-intubated patients

. Nasal Cavity Obstruction -1 . e.g : Deviated Nasal Septum . Oral Cavity Obstruction -2 . e.g : Tongue Fall against the posterior pharyngeal wall . it is the commonest cause . Laryngeal Spasm -3 .. e.g : Laryngitis . Tracheal & Bronchi Obstruction -4 " e.g : Foreign Body , Hyperactive air way " full of secretions :  Common Causes of Air way Obstruction in intubated patients

. High air way pressure The commonest cause -1 . Mechanical Obstruction -2 . e.g : Blood clot , secretary bluge . Physiological Obstruction -3 . e.g : Asthma induced bronchospasm .

There in NO Noisy Breathing in intubated patients

?  How to make patent Air way

Head Lift in non- traumatize patients Jaw Thrust in traumatize patients

.. Air way Instruments : Oropharyngeal Airway )1(

: Indication . Upper Air way Obstruction mainly by tongue fall : Contraindications . Semiconscious patient -1 ) bcz it will stimulate gag reflex causing vomiting & aspiration (

.Patient with multiple mandible fractures -2 .Patient with multiple tongue injuries -3 .Patient with hard teeth clenching -3

: Nasopharyngeal Airway )2(

: Indication Upper Air way Obstruction & the patient doesn't fit for . oropharyngeal air way insertion : Contraindications Basal Skull Fracture -1 " Absolute Contraindication " otherwise you will insert it to the brain & cause sever uncontrollable .complications

. Epistaxis -2 . Deviated Nasal Septum or other nasal deformity -3 . Fracture Nose -4 . Nasal Infection -5

: )COPA ) Cuffed Oropharyngeal Airway )3( . It is an Oropharyngeal Airway with a cuff to prevent any air leak

: ) Laryngeal Mask Airway ) LMA )4(

. Insert the mask in front of the larynx to ventilate the patient ! There are many sizes ; for adults & neonates . Use the largest size that your patient can accommodate : Advantages . Doesn't need an expert to insert it -1 . Easley administered -2 : Disadvantage . Doesn't prevent aspiration . It is not the ideal ventiltory device . It is used for life saving cases (Can be used electively in OR patients (empty stomach & no fear of aspiration : Contraindications . Full Stomach patients -1 " Prone position patients." bcz it will slip downward -2 . " Obesity or Pregnancy " bcz delay gastric emptying -3

: Laryngeal Tube )5(

.Insert it in the esophagus & inflate the 2 cuffs . It has an opening above the lower cuff to ventilate the larynx . The lower cuff will be inflated inside the esophagus to prevent aspiration : Disadvantage This opening might be inadequate to ventilate the patient to the limit he -1 .. need . If the patient suddenly vomit , it might cause esophageal rupture -2

: ) Pharyngeal Airway Express ) PAX Express )6( . It is a modified laryngeal tube with wider opening : Disadvantage !! This most traumatizing airway device

: Comb Tube )7( ( It is a combined tracheal & esophageal tube ( double lumen tube . Can enter the trachea & can enter the esophagus : Disadvantages . Expensive device -1 . Has limited sizes -2 . Used for adults only & not for pediatrics -3 . Not widely used

:) Oral Endotracheal Tube ) ETT )8( It has a cuff & hole opening called . Murphy's eyes . It is the ideal ventilatory device : Disadvantage . Needs an expert in intubation -1 . Need Laryngoscope guidance -2 . Liability of kinking inside -3 Causes stress response & tachycardia especially in hypertensive -4 . patients . Causes teeth trauma -5 . might injure the pathway -6 In prolonged intubation of ICU patients more than 15 days it causes -7 . stenosis & tracheal damage

: )Right angle Endotracheal Tube )RAE )9( . Same as the original ETT but with a curve of a right angle Useful for ophthalmic , ENT & facial plastic surgeries bcz the original . ETT might create difficulty for the surgeon to work freely in that field

: Armored Endotracheal Tube )10( .. More Rigid , doesn't kink : Suitable for . Neurosurgeries -1 . Faciomaxillary surgeries -2 . Dental Surgeries -3

: Pediatric Endotracheal Tube )11( . Without cuff

: Double Lumen Endotracheal Tube )12(

. There is Rt and Lt Double Lumen Endotracheal Tubes Double Lumen Endotracheal Tubes are designed so that one lung may be isolated from the other to facilitate selective ventilation of one lung or surgery within a hemithorax. Can be used for : 1- Thoracic surgeries . 2- Sever kyphoscoliosis surgery . 3- Pulmonary surgeries ( Abscess , Cancer ,…) ? Q : What is the difference between it & the Comb Tube

: Laryngoscope )13(

: LASER resistant Endotracheal Tube )14( (Same as the original ETT ( with metallic springs To prevent any explosion due to O2 reaction

: Magill`s Forceps )15(

: Can be used to . Direct the endotracheal tube -1 . Remove foreign body -2 . Put some gauze to absorb fluid or blood leak -3

: Bougie )16( . Used as a guidance for ETT in case of difficult air way intubation

: Stylet )17( !! Similar to bougie , used to facilitate the pathway for ETT insertion

: Ambo Bag )18(

: It has 3 unidirectional valves . Inspiratory valve -1 . Expiratory valve -2 . Infiltration valve -3 Can be connected to face mask , to ETT or LAM . It is a very useful Mobile Ventilator : Used for . Emergency Ventilation any where : OR , ER , Ambulance-1 . Electively for transportation of ventilative patients -2

: Face Mask )19( . For Oxygenation