AIRWAY EQUIPMENTS

PRESENTER: Dr.RAGUPATHY-JR
Dr.SHALIMA-JR

MODERATORS: Dr.KULBHUSHAN
Dr.KONICA
FACE MASK
It is used to ventilate and administer gases to the
patient without introducing any apparatus into the
patient’s mouth.
PARTS
BODY
EDGE OR SEAL
MOUNT OR CONNECTOR
BODY
It is the main part of mask. Mostly it is transparent to
allow observation for vomitus, secretions, blood, position
of lips, exhaled moisture.

SEAL
This is soft part that contacts the face.
Two types: 1) Inflatable
2) Flap type
CONNECTOR
SIZE: 22 mm internal diameter.
It is connected to the machine end.
HOOKS may be placed around the connector to
allow a mask strap to be attached.
SIZES
SIZE USE
0 INFANT
1 SMALL
CHILD
2 CHILD
3 SMALL
ADULT
4 ADULT
5 LARGE
ADULT
Selection of appropriate size mask: From nasal bridge to
above mental crease.
Choose the smallest possible mask to reduce the dead
space.
POSITION OF PATIENT
 To improve the airway when using facemask include
Head tilt, Chin lift, Jaw thrust and Elevation of the
shoulders with a towel or blanket.
MILS: Manual Inline Stabilisation in case of cervical spine
injury patients.
MILS
Technique:
An assistant standing at the head grasp the mastoid
process with the fingertips, with the occiput in the
palms of the hand to stabilise the neck.
Definition of Difficult mask ventilation
Han defined as inadequate, unstable, or requiring, two
providers with or without muscle relaxant

EL Ganzouri defined as inability to obtain chest

exertion suffient to maintain a clinically acceptable
capnogram wave.

Reference: Hagberg and benumof, chap: 8, p. no. 179.

Langeron defined as if one or more present

1) Inability of the unassisted anesthesiologist to maintain

oxygen saturation >92% using 100% oxygen.
2) Significant gas leak by the face mask.
3) Need to increase gas flow to >15L/min and to use oxygen
flush valve more than twice.
4) No perceptible chest movement.
5) Need to perform a two handed mask ventilation technique.
6) Change of operator required.
PREDICTOR OF DIFFICULT MASK
VENTILATION
L- Look externally
E- Evaluation of 3-3-2 score
M- Mallampati score
O- Obstruction
N- Neck mobility
Others:
Snoring
Macroglossia
MASK VENTILATION TECHNIQUES

1) One hand method

2) Two hand method
3) Two handed jaw thrust
4) Claw hand technique
One hand method
The thumb and index finger are placed on the body of
mask for giving downward pressure to prevent leak.
The remaining finger three fingers are placed on the
mandible avoiding the soft tissue compression.
This is known as E-C technique where thumb and index
finger form alpgabet C and remaining three fingers form
alphabet E.
TWO HAND METHOD
The thumbs are placed on either side of the mask body
The index fingers are placed under the angles of the jaw
The mandible is lifted & head is extended
RENDELL BAKER SOUCEK MASK
Mask ventilation for tracheostomised case
Used over the tracheostomy stoma for controlled and
assisted ventilation.
Placed around the stoma with the nasal portion pointing
in a caudal direction
so that the mandibular curve rests on
the tracheal region and the apex on
the supreasternal notch.
Advantage:
Minimum dead space (4-8ml)
ENDOSCOPIC MASK
It allows the ventilation
during endoscopic procedures.

SCENTED MASK:
It has a pleasant odour to make preoxygenation and
inhalational anaesthesia more acceptable.
Advantage: Useful in paediatric population
FOR EDENTULOUS PATIENT
Challenges: Loss of buccinator muscle tone causing hollow
cheeks leading to leakage of gases with minimal facial fat
 Techniques to improve the mask fit:
 Pack the gap between mask & cheeks with gauze pieces
 Insert the inferior margin of the mask b/w gingiva of the
mandible and the lower lip
 Pulling the cheeks with index fingers
PEARLS:
Mask ventilation improves when muscle relaxant is
administered.
ADVANTAGES OF FACE MASK
1) Lower incidence of sore throat (Mask> SGA >ETT)
2) Requires less anesthetic depth
3) Muscle relaxant not required

Disadvantages:
1) Dermatitis
2) Nerve injury
3) Gastric inflation
4) Jaw pain
5) Eye injury
6) Cervical spine injury
7) Latex allergy
8) Environmental pollution
 AIRWAY ADJUNCTS

Oropharyngeal airway

Nasopharyngeal airway
PURPOSE:
To maintain the airway patency
Under general anesthesia, the muscle of the floor of
mouth and pharynx supporting the tongue relax
which causes airway obstruction.
OROPHARYNGEAL AIRWAY
(Guedel’s Airway)
PARTS

Flange
Air channel

Bite portion
SIZES
Guedel’s airway has color coding according to the sizes
which varies from 000 to 5
How to choose the size
It is assessed by holding the airway next to the
patient’s incisors and the tip to the angle of the
mandible.
HOW TO USE
 Pharyngeal reflex and laryngeal reflex shoud be
suppressed to avoid cough and laryngospasm.
The jaw is opened with left hand
Lubrication of airway adjunct may smoothen the insertion
and avoid the trauma.
INSERTION TECHNIQUE
1) Lubricated airway adjunct: Insert it following normal
curvature of pharynx with convex side up.
2) Reverse method: Inserted with concave side facing up
and rotated by 180 degree after entering the oral cavity.
DISADVANTAGE:
It is difficult to use in awake
patients.
NASOPHARYNGEAL AIRWAY
INSERTION:
Each side of the nose should be inspected thoroughly
for size, patency or presence of any growth.
The nasal airway should lubricated thoroughly before
insertion.
A vasoconstrictor may be applied to the nostril to avoid
the trauma.
TECHNIQUE:
The tip of the nose should push upwards and
posteriorly to straighten the pathway.
The airway is held with the bevel against the septum
and gently advanced posteriorly while being rotated
back & forth.
Avoid forceful insertion.
SIZE SELECTION
The appropriate size is selected by the matching the
distance from the nostril to the tragus of the ear.
ADVANTAGES:
1) It is better tolerated than the oropharyngeal airway if the
patient has intact reflexes.
2) Can be used in patients with poor dendition, trauma or
pathology in oral cavity.
3) Can be used for nasotracheal intubation and fibre optic
endoscopy.
4) Limited mouth opening.
5) Awake fibreoptic insertion
6) Ventilation in emergency cases
CONTRAINDICATION
Basilar skull fracture
Nasal deformity
Patient on anticoagulation
H/o recent nasal bleed
DISADVANTAGES:
Trauma
Tissue edema
Ulceration and necrosis
Latex allergy
Foreign body insertion
Perforation
Dislodgement
LARYNGOSCOPES
It is an instrument used to visualise the larynx and
surrounding structures either by displacing the soft
tissues or by optical aids.
The main purpose of laryngoscope is for intubation.
PARTS
BASE: The part that attaches the handle. It has
a slot for engaging the hinge pin of the handle.
The end of the base is called HEEL.
TONGUE: The part used to swipe the tongue
aside.
FLANGE: It projects of the tongue and
connected to it by the WEB.
TIP: It is blunt and used to elevate the tongue.
BULB: It is an halogen bulp – light source
SIZES OF BLADES:
SIZE PATIENT TYPE
000,00 Small premature
infant
0 Neonate
1 Small child
2 Child
3 Adult
4 Large adult
5 Extra large adult
HANDLE
Part of laryngoscope thet held in hand.
This will helps to hold the blades which is
detachable.
It contains batteries to the light source
PATIL SYRACUSE HANDLE can able to hold blades
in four different angles 180º,135 90*,45*.
TYPES OF LARYNGOSCOPES

.
MILLERS BLADE (straight blade)
It is used in pediatric and adult pt.
The distsl 2inch of the blade was curved upwards to
allow lift of epiglottis especially floppy epiglottis.
This blade could be inserted anterior or posterior to
the epiglottis.
Better vision with a straight blade when compared to
curved blade in anterior larynx.
DISADVANTAGE: light source would disappear
under the tongue and tongue tends to bulge in front
of blade.
SIZES OF MILLERS BLADE:
Available sizes are 00,0,1,2,3,4.
MACINTOSH BLADE (CURVED BLADE)
It has a curved spatula, vertical height is raised and
the flange is turned to the left. The tongue,
web, flange form a reverse Z in cross section.
SIZES: Available are 0,1,2,3,4,5.
TECHNIQUES OF USE:
Optimal position of laryngoscopy:
35º lower cervical flexion and 80degree head
extension at the atlanto occipital level so called
sniffing position.
The blade is inserted at right side of the mouth.
Once the right tonsillar fossa is visualised,the blade
tip is moved toward the midline and then advanced
behind base of tongue to expose the vocal cord.

IF LARYX IS NOT VISUALISED THEN?

Displace the larynx by external
Backward,Upward,Rightward Pressure (BURP) ON
THE THYROID CARTILAGE.
PEARLS: It is important not to use the teeth as a
fulcrum.
DENTURE: Inspect the dental condition of the pt.
it is better to remove the loose tooth, artificial
denture as it may dislodge and may aspirate during
laryngoscopy.
VIDEOLARYNGOSCOPY
It is reserved for anticipated difficult intubation or
facilitating nasotracheal intubtion.
It has a rigid curved blade with camera optics built
into blade
A small camera in the blade or a fibre optic bundle
transmit the image to the monitor.
TYPES
TECHNIQUE
The blade should be inserted in midline under direct
vision until the tip is out of view, then operator should
look the monitor and advance the blade until the
epiglottis is identified to lift it for visualization of
glottis.

ADVANTAGES:
Images is larger and brighter
Better success rate
Alignment of oral,pharyngeal,tracheal axes not required.
FIBREOPTIC LARYNGOSCOPE
PRINCIPLES:
 The pathways through which the illumination and
the image pass has thousands of very fine glass fibres
and it surrounded by a thin cladding of another type
of glass with different refractive index. As a result the
difference in refravtive index makes the light
undergoes total internal reflection (TIR) along the
fibre.
ADVANTAGES
Improved assistance
Improved teaching
Facility to record images for review
Thank you