Airway Management气道管理详解课件.ppt

,Difficult Airway,Ding Lirong,Difficult Airway,Definition :,The formal training anesthesiologist or doctors in,emergency and ICU fail to ventilate patients by,mask or intubate patients with conventional,laryngoscopy .,The ASA defines a difficult airway as failure to,intubate with conventional laryngoscopy after,three attempts and/or failure to intubate with,conventional laryngoscopy for more than 10 min.,Difficult Airway,Categories :,?,The difficult airway can be divided into the,recognized difficult airway,and the,unrecognized difficult airway,?,the latter presents the greater challenge for,the anesthesiologist.,Evaluation of Difficult Airway,History:,A history of difficult airway management ;,Arthritis or cervical disk disease ; Infections,of the floor of the mouth ; a history of,obstructive sleep apnea ; Tumors or trauma,associated with airway; Previous surgery,radiation, or burns ; Scleroderma ; Trisomy,21 patients; Dwarfism,Evaluation of Difficult Airway,Physical examination :,Specific findings that may indicate a difficult airway include,the following:,?,Inability to open the mouth(1.5cm),?,Poor cervical spine mobility.,?,thyromental distance is less than 6 cm,?,Receding chin (micrognathia).,?,Large tongue (macroglossia).,?,Prominent incisors.,?,Short muscular neck.,?,Morbid obesity,Evaluation of Difficult Airway,Mallampati classification :Assessment is made,with the patient sitting upright, with the head,in the neutral position, the mouth open as,wide as possible, and the tongue protruded,maximally. The modified classification,includes the following four categories :,Evaluation of Difficult Airway,The modified Mallampati classification includes the,following four categories :,?,Class I. Faucial pillars, soft palate, and uvula are,visible.,?,Class II. Faucial pillars and soft palate may be,seen, but the uvula is masked by the base of the,tongue.,?,Class III. Only soft palate is visible. Intubation is,predicted to be difficult.,?,Class IV. Soft palate is not visible. Intubation is,predicted to be difficult.,Evaluation of Difficult Airway,Treatment of Difficult Airway,Treatment of recognized difficult airway:,Awake intubation,Local anesthesia:,?,4% lidocaine gargle, followed by a lidocaine spray or,nebulizer, is used to decrease upper airway sensation.,?,Translaryngeal injection of local anesthetic through the,cricothyroid membrane anesthetize the glottis and upper,trachea.,Sedation:,Sedatives such as midazolam, propofol, and fentany may,be used in addition to the nerve blocks,Keep Spontaneous breathing is important.,Fiberoptic intubation,Indications,?,The flexible fiberoptic laryngoscope or,bronchoscope can be used in both awake and,anesthetized patients to evaluate and intubate,their airways. It can be used for both nasal and,oral endotracheal intubation and should be used,as a first option in an anticipated difficult airway,?,Initial fiberoptic intubation is recommended for,patients with known or suspected cervical spine,pathology, head and neck tumors, morbid,obesity, or a history of difficult ventilation or,intubation.,Fiberoptic intubation,Treatment of Difficult Airway,Treatment of unrecognized difficult airway:,When fail to mask ventilation:,?,LMA-first choise,?,Tracheoesophageal combitube,?,Jet ventilation,?,Fiberoptic intubation,?,Cricothyroid membrane incision,?,Tracheotomy,Tracheoesophageal combitube,Treatment of Difficult Airway,Cricothyroid membrane incision,Treatment of Difficult Airway,