Airway Management

Airway Management

1. Basic Airway Manoevres

   • Asses the airway
     • Head tilt chin lift
     • Jaw thrust (suspected c-spine and larger patients)

2. Airway Adjunct

   • Oropharyngeal (Guedel
     • Indication: Unconscious patients (as no gag reflex)
     • Size: Measured by placing flange at lips and the tip to the angle of the jaw.
     • insertion technique: upside down & then rotated 180 degrees. (children: Inserted right side up
   • Nasopharyngeal
     • Indication: Mostly used on a conscious patient/ when there is a gag reflex. (better tolerated)
     • Size: Nares to the tip of the tragus. The maximum diameter is approximately the diameter of the patients 5th Digit.
     • Tube is lubricated with a water-based lubricant. Inserted device until the flared end rests against the nares

3. Laryngeal Mask Airway

   • Indication: Supports and maintains airway without intubation. Shorter procedures when ET intubation is not necessary
   • Uses: 1.Inhalational anaesthesia 2. Maintaining airway during difficult intubation 3. Emergency management of airway in failed intubation
   • Insertion: Hold like a pen. Slide along the hard palate with gentle pressure until resistance is felt. Once in place, inflate the cuff. (Note: approximately 8cm of tube protrudes from the mouth).

4. I-Gel

   • Made from a thermoplastic elastomer (gel-like). Creates a non-inflatable anatomical seal.
   • Avoids compression trauma that can occur with inflatable supraglottic airway devices.
   • Indication: Maintainance of airway (fasted patients, during spontaneous or intermittent positive pressure ventilation, resuscitation, and as a conduit for intubation under fibreoptic guidance in a known difficult or unexpectedly difficult intubation.
   • Insertion: Lubricate device. Position to face I-gel cuff towards chin. Inset towards hard palate. Insert until resistance is felt.

5. Endotracheal Tube

   • Indication: Failure to obtain an airway by simple airway opening maneuvers (eg: OPA insertion) Airway protection (eg: from blood, broken teeth) Provides a secure airway for transport Controls ventilation in the unconscious/head injured patient
   • Types: Uncuffed tube (1st choice in children <8yrs, to avoid oedema at the cricoid ring.) Cuffed tube (preferable for >8rs) Nastrotracheal intubation Indicated in dental procedures, intraoral or oropharyngeal surgeries. Also used in patients with c-spine disease/instability (contraindicated in base of skull fracture)
   • Insertion: Use laryngoscope to visualise tube passing vocal cords. Calculate how far to insert tube AUSCILTATE Secure with tape/Tie
   • Size Guide
     • Adult
       • Female
         • Diameter: 7.0-8.0 Length: 22cm (at lips) 21cm (at teeth)
       • Male
         • Diameter: 8.0-9.0 Length: 23cm (at lips) 22cm (at teeth)
     • Length
       • length (at lips) of oral tube is: Age/2 + 12
       • Endotracheal tube length at  nostril (cm): 15 + age/2
     • Diameter
       • >12 months: FORMULA (Age in years / 4) + 4 (uncuffed) > 8years: (Age in years / 4) + 3 (cuffed)
         • In general it is good practice to have the estimated tube size ± 0.5mm (0.5 mm smaller and 0.5 mm larger) ready at the bedside.
       • Neonate (0-6 months): - 3.0 mm
       • 6-12 months: -3.5mm -4.0 mm
     • Depth
       • 3xETT (e.g. Child, 4 yrs old, ETT 5.0 x 3 = inserted depth of 15cm)

6. Anatomy

   • Children vs. Adult
   • View down laryngoscope

Images and files in the map