DEPARTMENT OF ANESTHESIOLOGY - Prolonged mask ventilation and head strap

Clinical Clerkship are associated with pressure injuries to the

San Beda College of Medicine facial and trigeminal nerve branches
- Corneal abrasions may occur if the eyes are
not protected
TOPIC: AIRWAY MANAGEMENT

AIRWAY ANATOMY JOSEPH CLOVER

◦ 1st englishman to urge
- Nasopharynx: from the nose to the pharynx practice of thrusting
- Oropharynx: from the mouth to the pharynx patient’s jaw.
- Pharynx: begins at the junction of the ◦ To overcome obstruction
nasopharynx and oropharynx and extends of upper airway by the
to the cricoid cartilage. tongue
- Larynx: a group of cartilages and muscles
that act to protect the vocal cords.
Paired: arytenoid, cuneiform, corniculate DIFFERENCE BETWEEN ADULT AND PEDIATRIC
Unpaired: thyroid, cricoid, epiglottic AIRWAY

NERVOUS SUPPLY OF THE AIRWAY

1. Lingual nerve: sensation to the anterior

two-thirds of the tongue
2. Glossopharyngeal nerve: sensation to
posterior one-third of the tongue, roof of
pharynx, tonsils, underside of soft palate
3. Superior laryngeal nerve
a. External branch: motor to
cricothyroid muscle, sensation to
anterior subglottic mucosa
b. Internal branch: sensation from
NASAL AND ORAL AIRWAYS
the epiglottis to the vocal cords.
4. Recurrent laryngeal nerve: motor to
- Create an opening between the tongue and
intrinsic muscles of the larynx (except
the posterior pharyngeal wall so that the air
cricothyroid)
can pass through.
- Oral airways can cause laryngospasm when
placed in an awake or lightly anesthetized
POSITIONING
patients
- Nasal airways can be measured by the
- Head in sniffing position
length of the patient’s nose to the meatus
- Mask held with left hand, right hand is used
of the ear.
to squeeze the anesthesia bag
- Contraindications in using nasal airways are:
- Thumb and forefinger are positioned in “C”
bleeding disorders, basilar skull fractures
position around the mouth orifice
and significant nasal deformities.
- Third and fourth finger lift the mandible
toward the mask
- Fifth finger lifts the angle of the mandible
and creates an anterior jaw thrust.
- Only 20-25 cm H20 pressure should be used
during positive pressure ventilation via
mask.

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HOW TO ASSESS THE AIRWAY

EXAMPLES OF PATIENTS WITH DIFFICULT AIRWAY