AIRWAY

MANAGEMENT
GUIDED BY: PRESENTED BY
DR. GAGAN KHARE DR. NASIM
(PROFESSOR)
 CONTENTS
• AIRWAY ANATOMY
• PEDIATRIC VS ADULT AIRWAY
• INDICATIONS OF AIRWAY MANAGEMENT
• AIRWAY EXAMINATION
• BASIC AIRWAY MANEUVERS
• AIRWAY ADJUNCTS
• CRICOTHYROIDOTOMY
• TRACHEOSTOMY
• AIRWAY MANAGEMENT IN TRAUMA PATIENTS
• CONCLUSION
• REFERENCES
 AIRWAY ANATOMY

UPPER AIRWAY LOWER AIRWAY

Pharynx Trachea
Epiglottis Bronchi
Alveoli
Glottis
Lung tissue, consisting of lobes and lobules
Vocal cords (3 on the right and 2 on the left)
Larynx Pleura
PEDIATRIC VS ADULT AIRWAY
• More rostral larynx
• Relatively larger tongue
• Angled vocal cords
• Differently shaped epiglottis
• Funneled shaped larynx
• Narrowest part of pediatric airway is cricoid cartilage
• Narrower tracheas which is more flexible and softer.
• Depend more on diaphragm for breathing.
 INDICATIONS FOR AIRWAY
MANAGEMENT

Obtain and Correct

maintain a deficient Protect
patent gas the airway
airway exchange
AIRWAY EXAMINATION
MALLAMPATI SCORE
CORMACK & LEHANE GRADING
BASIC AIRWAY MANEUVERS
• Head tilt/ Chin lift
• Jaw thrust
• Modified jaw thrust
• Sellick’s maneuvre
HEAD TILT/CHIN LIFT
JAW THRUST
MODIFIED JAW THRUST
AIRWAY ADJUNCTS
• Oropharyngeal airway
• Nasopharyngeal airway
• Laryngeal mask airway
• Bag mask ventilation
• Combitube
OROPHARYNGEAL AIRWAY
NASOPHARYNGEAL AIRWAY
BAG MASK VENTILATION
• Bag-mask ventilation is the cornerstone of
basic airway management.
• When a second person is available to
provide ventilations by compressing the
bag, a two-hand technique can be used.
• The surgeon creates opposing semicircles
with the thumb and index finger of each
hand to form a ring around the mask
connector and hold the mask on the
patient’s face.
• Then, the mandible can be lifted with the
remaining digits.
SINGLE PERSON BVM TWO PERSON BVM
LARYNGEAL MASK AIRWAY
COMBITUBE
 ENDOTRACHEAL INTUBATION
• Endotracheal intubation
provides an artificial
medium between the
atmosphere and the
patient’s trachea for the
purpose of alveolar gas
exchange or protection of
the lungs from
inappropriate substances.

OROTRACHEAL INTUBATION
NASOTRACHEAL INTUBATION
NASOTRACHEAL
INTUBATION
RAPID SEQUENCE INTUBATION

• Rapid sequence intubation (RSI) is the virtually simultaneous

administration of a sedative and a neuromuscular blocking
(paralytic) agent to render a patient rapidly unconscious and flaccid
in order to facilitate emergent endotracheal intubation and to
minimize the risk of aspiration. ADVANTAGES
 Facilitates and expedites endotracheal intubation
 Increased success rate
 Decreased time to intubation
 Minimizes trauma during laryngoscopy
 Minimizes hypoxia and hypercapnia
 Minimizes risk of aspiration
 Minimizes hemodynamic effects of intubation
CRICOTHYROIDOTOMY
• Emergency cricothyroidotomy is one of the last resort and potentially
lifesaving procedures for maxillofacial trauma patients who cannot be
intubated or ventilated.
 EMERGENCY
CRICOTHYROIDOTOMY
TRACHEOSTOMY

 Tracheotomy : Greek origin: ‘tom’- ‘to

cut’ the trachea
Surgical opening of the trachea

 Tracheostomy : Greek origin: ‘stom’-

‘mouth’
Creation of a stoma between trachea and
cervical skin
INDICATIONS
COMPLICATIONS
AIRWAY MANAGEMENT IN
TRAUMA PATIENTS
CAUSES OF AIRWAY INJURY SPECIFICALLY
RELATED TO MAXILLOFACIAL TRAUMA
SIGNS OF AIRWAY COMPROMISE
CONCLUSION
• Airway management is an extremely important aspect of the practice
of anesthesiology and critical care.
• A firm basis in airway anatomy is needed.
• Skills such as mask ventilation, endotracheal intubation, LMA
placement are necessary.
• In the case of a difficult airway, a logical algorithm and airway
equipment assist the clinician in safely managing the situation.
• Airway management is a very important skill for all clinicians to have.
• Assess, Reassess, and Reassess again!!!
REFERENCES
• Airway Management in Emergencies: George Kovacs, J.Adam Law
• Benumof and Hagberg’s Airway Management: Carin A. Hagberg
• Oral and Maxillofacial Surgery 3rd Edition: Fonseca
• Maxillofacial Injuries Vol 1: Rowe & Williams
• Peterson Principles of Oral & Maxillofacial Surgery 2nd Edition
• Maxillofacial Trauma & Esthetic Facial Reconstruction 2nd Edition:
Peter Ward Booth
THANK YOU