MALLAMPATI SCORING FOR AIRWAY ASSESSMENT

CORMACK AND LEHANE GRADING[ CL grading] ( DIRECT LARYNGOSCOPIC GRADING)

DOUBLE LUMEN TUBE ( PORTEX)
OROPHARYNGEAL AIRWAY IN PLACE
NASOPHARYNGEAL AIRWAY IN PLACE
LARYNGEAL MASK AIRWAY IN PLACE

UNCUFFED PEDIATRIC TRACHEAL TUBE

LARYNGECTOMY TUBE
DIRECT LARYNGOSCOPY
NEURO MUSCULAR TRANMISSION
IN A NUTSHELL
ANAESTHESIA EQUIPMENTS
DR.RAMAKRISHNA CHAITANYA.K
MBBS,DA,DNB,FCCS
ANATOMICAL FACE MASK

• Available in sizes 00 —> 4

• Increases Dead space
• Can cause abdominal distention
• Increases chances of aspiration
• Maneuver used : triple maneuver
• Triple maneuver includes head tilt, chin lift, and jaw thrust
AIRWAYS

• Gudels airway
• Helps in preventing tounge fall back
• Requires deeper planes of sedation to insert
• Can stimulate gag reflex
• Length of airway = Distance between tip of nose & tragus + 1 inch
• NASO-PHARYNGEAL AIRWAY
• Also helps in preventing tounge fall back
• Better tolerated by patients
• Contraindicated in patients with basal skull fracture/
bleeding disorders
LARYNGEAL MASK AIRWAY
• Good alternative to provide
oxygenation
• Invented by DR.ARCHIE BRAIN.
• Available in sizes 1-4
•USES
• Emergency airway/ Difficult intubations
• Elective procedure for minor surgeries.
•ADVANTAGES:
• Easy to insert (Even paramedical staff can insert)
• Can be used in cervical instability
• No laryngoscopy required
• No muscle relaxants required(Can be used in awake patients)
•DISADVANTAGES:
• Does not prevent aspiration
• can cause Laryngospasm
 •Other types of LMA

•Intubating LMA
•Pro-seal LMA (suction port for stomach decompression)
•Laryngoscope
•Commonly used laryngoscopes:
• Macintosh (curved blade)
•neonates -straight blade (magill)

•Head & neck position for laryngoscope

•extension at Atianto-occipital joint & flexion at cervical spine
•Teeth most vulnerable to damage - upper Incisors
•ENDO TRACHEAL TUBES
•2 types: cuffed /un-cuffed
•Cuffed used mostly in adults
•Protects from aspiration
•Cuff to be filled with air.
•pressure should be less than 25mmhg
•In small children un-cuffed tube should be used (<6 yrs)
•Confirmation of position:
•Types of endo tracheal tubes: based on cuff type and material
made
•Red Rubber
• Non transparent
• Radiolucent
• mist Absent
• Cuff = low volume, high Pressure
• ↑Chances of tracheal injury
• PVC type endo tracheal tubes:
• Single use ( disposable)
• Can see the mist formation
• Radio opaque line present
• Low pressure high volume cuffs
• Less chances of tracheal injury
• How to calculate Size of ET tube
• Adult:
• Male : 8/8.5/9 no.
• Female : 7.0/7.5/8 no.
• children
• <6 years - Age (years)/3 + 3.5
• > 6 years - Age/4+4.5
• Length of tube
• For oral intubation Age/2 + 12 cms
• For nasal intubation add 3cms to oral length
• Reflex response to Intubation/laryngoscopy :
• CVS - tachyarrhythmia, hypertension
• RESP- laryngeal spasm ( if no adequate depth is present)
• CNS – increases intracranial tension
• HORMONAL – profound increase in cortisol and
catecholamines levels
• Methods to inhibits :
• xylocard iv\xylocaine spray\ opoids\beta blockers\ calcium
channel blockers
Other types of ET tubes

• Spiral embedded tube • RAE preformed tube (oxford)

\flexometallic\armoured • oral and dental surgeries like cleft lip
• head and neck surgeries and palate

Robert Shaw & Carlen's tube - double lumen for thoracic

surgery i.e. for one lung ventilation
• Nasal Intubation Indications
• Oral surgery/ Fracture mandible
• Inadequate mouth opening ( awake intubation)
• Advantage
• Better tolerated by awake patients
• Oral hygiene Can be maintained
• Disadvantages
• infection( sinusitis)
• Contraindication
• Basal skull fracture/ CSF rhinorrhoea
• Nasal mass/ Adenoids
• Coagulopathy
• Oxygen delivery devices

• High flow systems: - These are fixed performance

device so delivers accurate oxygen (error is only ± 2%)
and therefore possible to regulate oxygen delivery.

• These include venture mask, special nebulizers, and

high air flow blenders.
• Low flow system-Nasal cannula, Oxygen mask, tent, hood
• variable performance devices so inaccurate and not possible to
regulate oxygen delivery
•Reservoir Bag (breathing bag)
•For neonates - 250 ml
•For infant & small children - 500 ml
•For adolescents - 1000 ml
•For adults - 2000 ml
AMBUBAG

- Artificial manual breathing unit

- Max. 02 that can be given by AMBU Bag - 100%
DR. APREESH SHARMA
MBBS (MAMC)
MD –ANAESTHESIA (MAMC)
DNB FELLOWSHIP-CRITICAL CARE MEDICINE

ANAESTHESIA

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ANAESTHESIA MACHINE

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PRESSURE GAUZE

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MAPLESON CIRCUITS

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MAPLESON CIRCUITS

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BAIN CIRCUIT-COAXIAL
CIRCUITS

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CIRCLE SYSTEM

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AIRWAY DEVICES
ORO-PHARYNGEAL AIRWAY
NASOPHARYNGEAL AIRWAY
BAG & MASK
LARYNGEAL MASK AIRWAY
LARYNGEAL MASK AIRWAY

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LMA PROSEAL (PLMA)
LMA PROSEAL (PLMA)
INTUBATING LMA(LMA FASTRACK)
INTUBATING LMA(LMA FASTRACK)
ENDOTRACHEAL TUBE
ET

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LARYNGOSCOPE

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POSITION FOR LARYNGOSCOPY

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ET WITH STYLET

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DOUBLE LUMEN TUBE
DLT

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RAE TUBE

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FLEXOMETALLIC(ARMOURED) TUBE
FLEXOMETALLIC(ARMOURED) TUBE
RED RUBBER TUBES
???
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