1、 Difficult Airway Ding Lirong Difficult Airway Definition : The formal training anesthesiologist or doctors in emergency and ICU fail to ventilate patients by mask or intubate patients with conventional laryngoscopy . The ASA defines a difficult airway as failure to intubate with conventional laryng
2、oscopy after three attempts and/or failure to intubate with conventional laryngoscopy for more than 10 min. Difficult Airway Categories : ?The difficult airway can be divided into the recognized difficult airway and the unrecognized difficult airway ? the latter presents the greater challenge for th
3、e anesthesiologist. Evaluation of Difficult Airway History: A history of difficult airway management ; Arthritis or cervical disk disease ; Infections of the floor of the mouth ; a history of obstructive sleep apnea ; Tumors or trauma associated with airway; Previous surgery, radiation, or burns ; S
4、cleroderma ; Trisomy 21 patients; Dwarfism Evaluation of Difficult Airway Physical examination : Specific findings that may indicate a difficult airway include the following: ?Inability to open the mouth(1.5cm) ?Poor cervical spine mobility. ?thyromental distance is less than 6 cm ?Receding chin (mi
5、crognathia). ?Large tongue (macroglossia). ?Prominent incisors. ?Short muscular neck. ?Morbid obesity Evaluation of Difficult Airway Mallampati classification :Assessment is made with the patient sitting upright, with the head in the neutral position, the mouth open as wide as possible, and the tong
6、ue protruded maximally. The modified classification includes the following four categories : Evaluation of Difficult Airway The modified Mallampati classification includes the following four categories : ?Class I. Faucial pillars, soft palate, and uvula are visible. ?Class II. Faucial pillars and so
7、ft palate may be seen, but the uvula is masked by the base of the tongue. ?Class III. Only soft palate is visible. Intubation is predicted to be difficult. ?Class IV. Soft palate is not visible. Intubation is predicted to be difficult. Evaluation of Difficult Airway Treatment of Difficult Airway Tre
8、atment of recognized difficult airway: Awake intubation Local anesthesia: ?4% lidocaine gargle, followed by a lidocaine spray or nebulizer, is used to decrease upper airway sensation. ?Translaryngeal injection of local anesthetic through the cricothyroid membrane anesthetize the glottis and upper tr
9、achea. Sedation: Sedatives such as midazolam, propofol, and fentany may be used in addition to the nerve blocks Keep Spontaneous breathing is important. Fiberoptic intubation Indications ?The flexible fiberoptic laryngoscope or bronchoscope can be used in both awake and anesthetized patients to eval
10、uate and intubate their airways. It can be used for both nasal and oral endotracheal intubation and should be used as a first option in an anticipated difficult airway ?Initial fiberoptic intubation is recommended for patients with known or suspected cervical spine pathology, head and neck tumors, m
11、orbid obesity, or a history of difficult ventilation or intubation. Fiberoptic intubation Treatment of Difficult Airway Treatment of unrecognized difficult airway: When fail to mask ventilation: ?LMA-first choise ?Tracheoesophageal combitube ?Jet ventilation ?Fiberoptic intubation ?Cricothyroid membrane incision ?Tracheotomy Tracheoesophageal combitube Treatment of Difficult Airway Cricothyroid membrane incision Treatment of Difficult Airway
